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. 2023 Jul 30;13(7):e070509.
doi: 10.1136/bmjopen-2022-070509.

Sex and gender differences in healthcare utilisation trajectories: a cohort study among Quebec workers living with chronic pain

Anaïs Lacasse  1   2 , Hermine Lore Nguena Nguefack  3   2 , G Page  4   5 , Manon Choinière  4   5 , Oumar Mallé Samb  3 , Joel Katz  6 , Nancy Ménard  2 , Bilkis Vissandjée  7   8 , Meriem Zerriouh  3   2 ; TorSaDE Cohort Working
Collaborators, Affiliations

Sex and gender differences in healthcare utilisation trajectories: a cohort study among Quebec workers living with chronic pain

Anaïs Lacasse et al. BMJ Open. .

Abstract

Objectives: Chronic pain (CP) is a poorly recognised and frequently inadequately treated condition affecting one in five adults. Reflecting on sociodemographic disparities as barriers to CP care in Canada was recently established as a federal priority. The objective of this study was to assess sex and gender differences in healthcare utilisation trajectories among workers living with CP.

Design: Retrospective cohort study.

Participants: This study was conducted using the TorSaDE Cohort which links the 2007-2016 Canadian Community Health Surveys and Quebec administrative databases (longitudinal claims). Among 2955 workers living with CP, the annual number of healthcare contacts was computed during the 3 years after survey completion.

Outcome: Group-based trajectory modelling was used to identify subgroups of individuals with similar patterns of healthcare utilisation over time (healthcare utilisation trajectories).

Results: Across the study population, three distinct 3-year healthcare utilisation trajectories were found: (1) low healthcare users (59.9%), (2) moderate healthcare users (33.6%) and (3) heavy healthcare users (6.4%). Sex and gender differences were found in the number of distinct trajectories and the stability of the number of healthcare contacts over time. Multivariable analysis revealed that independent of other sociodemographic characteristics and severity of health condition, sex-but not gender-was associated with the heavy healthcare utilisation longitudinal trajectory (with females showing a greater likelihood; OR 2.6, 95% CI 1.6 to 4.1).

Conclusions: Our results underline the importance of assessing sex-based disparities in help-seeking behaviours, access to healthcare and resource utilisation among persons living with CP.

Keywords: EPIDEMIOLOGY; Organisation of health services; PAIN MANAGEMENT; Quality in health care; STATISTICS & RESEARCH METHODS; Sexual and gender disorders.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study population selection. CCHS, Canadian Community Health Survey.
Figure 2
Figure 2
Healthcare utilisation trajectories in the whole study sample. Plain line: observed mean number of healthcare contacts. Interrupted line: estimated number of healthcare contacts by the GBTM. GBTM, group-based trajectory modelling.
Figure 3
Figure 3
Healthcare utilisation trajectories in males (left) and females (right). Plain line: observed mean number of healthcare contacts. Interrupted line: estimated number of healthcare contacts by the GBTM. GBTM, group-based trajectory modelling.
Figure 4
Figure 4
Healthcare utilisation trajectories in first (left), second (centre) and third (right) tertiles of gender index. Plain line: observed mean number of healthcare contacts. Interrupted line: estimated number of healthcare contacts by the GBTM. GBTM, group-based trajectory modelling.
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