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. 2018 Jun;63(6):404-409.
doi: 10.1177/0706743717745870. Epub 2018 Feb 6.

Geographic Clustering of Admissions to Inpatient Psychiatry among Adults with Cognitive Disorders in Ontario, Canada: Does Distance to Hospital Matter?

Christopher M Perlman  1 , Jane Law  1   2 , Hui Luan  3   4 , Sebastian Rios  1 , Dallas Seitz  5 , Paul Stolee  1
Affiliations

Geographic Clustering of Admissions to Inpatient Psychiatry among Adults with Cognitive Disorders in Ontario, Canada: Does Distance to Hospital Matter?

Christopher M Perlman et al. Can J Psychiatry. 2018 Jun.

Abstract

Objective: This study examined relationships among hospital accessibility, socio-economic context, and geographic clustering of inpatient psychiatry admissions for adults with cognitive disorders in Ontario, Canada.

Method: A retrospective cross-sectional analysis was conducted using admissions data from 71 hospitals with inpatient psychiatry beds in Ontario, Canada between 2011 and 2014. Data included 7,637 unique admissions for 4,550 adults with a DSM-IV diagnosis of Delirium, Dementia, Amnestic and other Cognitive Disorders. Bayesian spatial Poisson regression was employed to examine the relationship between accessibility of general hospitals with psychiatric beds and psychiatric hospitals, area-level marginalization, and hospitalization rate with the risk of admission to inpatient psychiatry among adults with cognitive disorders across 516 Forward Sortation Areas (FSA) in Ontario.

Results: Residential instability and the overall hospitalization rate were significantly associated with an increase in the relative risk of admissions to inpatient psychiatry. Accessibility to general hospitals and psychiatric hospitals were marginally insignificant at the 95% credible interval in the final model. Significant geographic clustering of admissions was identified where individuals residing in FSA's with the highest relative risk were 2.0 to 7.1 times more likely to be admitted to inpatient psychiatry compared to the average.

Conclusions: Geographic clustering of inpatient psychiatry admissions for adults with cognitive disorders exists across the Province of Ontario, Canada. At the geographic level, the risk of admission was positively associated with residential instability and the overall hospitalization rate, but not distance to the closest general or psychiatric hospital.

Keywords: GIS; cognitive disorders; dementia; geographic variation; inpatient psychiatry; spatial Poisson regression.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Estimated geographical variation in relative risk of admission to inpatient psychiatry among adults with cognitive disorders at the FSA level in Ontario, Canada. [Source of FSA map: Statistics Canada, 2017]. Note: Boxed area represents the Greater Toronto Area, which has been amplified.
See this image and copyright information in PMC

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