Article Figures & Tables
Figures
- Figure 1:
Flow diagram showing case selection. Note: HCV = hepatitis C virus, OHIP = Ontario Health Insurance Plan.
- Figure 2:
Net costs of care per 30 days by cost category for the prediagnosis (A), initial (B), late (C) and terminal (D) phases of care, stratified by residence within or outside of a First Nations community at matching date. Each cost is rounded to the nearest dollar and expressed in 2018 Canadian dollars. “Other” includes Ontario Health Insurance Plan nonphysician services, Assistive Devices Program, rehabilitation services, home care, complex continuing care and long-term care. Error bars represent 95% confidence intervals. Mean cost and net cost results stratified by community status can be found in Appendix 5, Supplemental Tables S8 and S9.
- Figure 3:
Net costs of care per 30 days by cost category for the prediagnosis (A), initial (B), late (C) and terminal (D) phases of care, stratified by sex. Each cost is rounded to the nearest dollar and expressed in 2018 Canadian dollars. “Other” includes Ontario Health Insurance Plan nonphysician services, Assistive Devices Program, rehabilitation services, home care, complex continuing care and long-term care. Error bars represent 95% confidence intervals. Mean cost and net cost results stratified by sex can be found in Appendix 5, Supplemental Tables S10 and S11.
Tables
Exclusion criterion Definition Spontaneous clearance Negative HCV RNA test result 12 mo after positive HCV antibody test result and no record of positive HCV RNA test result within 12 mo after first positive test result
Acute resolved Negative HCV RNA test result within 12 mo after positive HCV RNA test result and no record of HCV-related treatment between testing dates (Appendix 2, Supplemental Table S3, available at www.cmajopen.ca/content/9/3/E897/suppl/DC1)
The person never reverted to HCV RNA positive
HIV infection Record in Ontario HIV database
HIV diagnostic code in administrative data (Appendix 2, Supplemental Table S1)
HBV infection Positive HBV test result in Public Health Ontario testing records
HBV diagnostic code in administrative data (Appendix 2, Supplemental Table S1)
Note: HBV = hepatitis B virus, HCV = hepatitis C virus.
Resource category Included services* Outpatient visits Hospital outpatient clinic services, NACRS visits to dialysis clinics, NACRS visits to cancer clinics Physician services OHIP physician billings (including fee-for-service and most of the shadow billings†) Emergency department visits NACRS emergency department visits Same-day surgery Same-day surgery procedures Inpatient care Inpatient hospital admissions and OMHRS admissions to designated mental health beds Outpatient prescription Ontario Drug Benefit prescription claims Laboratory tests/services OHIP laboratory tests Other services OHIP nonphysician services, Assistive Devices Program, rehabilitation services, home care, complex continuing care and long-term care Note: NACRS = National Ambulatory Care Reporting System, OHIP = Ontario Health Insurance Plan, OMHRS = Ontario Mental Health Reporting System.
↵* Explanations of each administrative database can be found in Appendix 1. Additional details can be found in Appendix 2.
↵† Refers to submitting a claim for services provided for which physicians are paid a small percentage of the usual fee.
- Table 3:
Characteristics of Status First Nations people in Ontario with HCV infection and matched control participants by phase of care
Characteristic Cohort; no. (%) of people* Prediagnosis phase Initial phase Late phase Terminal phase Case
n = 2096Control
n = 3916Case
n = 2077Control
n = 3875Case
n = 130Control
n = 249Case
n = 297Control
n = 545Length of phase, mean ± SD, d 179 ± 0 179 ± 0 2714.5 ± 1248.5 2098.2 ± 966.0 1280.9 ± 1086.1 1092.2 ± 826.5 168.5 ± 40.2 168.3 ± 40.7 Demographic characteristics Age, yr Mean ± SD 36.7 ± 11.4 36.9 ± 11.5 36.7 ± 11.1 36.8 ± 11.2 50.1 ± 9.4 50.1 ± 9.3 48.8 ± 12.3 49.5 ± 12.2 Median (IQR) 36 (27–45) 36 (27–46) 36 (28–45) 36 (28–45) 50 (46–57) 51 (45–57) 50 (40–57) 51 (41–58) Age group, yr ≤ 29 665 (31.7) 1227 (31.3) 645 (31.1) 1221 (31.5) 6 (4.6) 10 (4.0) 25 (8.4) 35 (6.4) 30–39 579 (27.6) 1080 (27.6) 594 (28.6) 1087 (28.1) 9 (6.9) 19 (7.6) 49 (16.5) 78 (14.3) 40–49 545 (26.0) 1018 (26.0) 550 (26.5) 1005 (25.9) 45 (34.6) 82 (32.9) 68 (22.9) 134 (24.6) ≥ 50 307 (14.6) 591 (15.1) 288 (13.9) 562 (14.5) 70 (53.8) 138 (55.4) 155 (52.2) 298 (54.7) Rural mail delivery area No 2088 (99.6) 3897 (99.5) 2070 (99.7) 3863 (99.7) 130 (100.0) 249 (100.0) –** 539 (98.9) Yes 8 (0.4) 19 (0.5) 7 (0.3) 12 (0.3) 0 (0.0) 0 (0.0) –** 6 (1.1) Sex Female 944 (45.0) 1728 (44.1) 945 (45.5) 1762 (45.5) 42 (32.3) 80 (32.1) 116 (39.1) 205 (37.6) Male 1152 (55.0) 2188 (55.9) 1132 (54.5) 2113 (54.5) 88 (67.7) 169 (67.9) 181 (60.9) 340 (62.4) First Nations community status Outside of community† 1714 (81.8) 3142 (80.2) 1695 (81.6) 3075 (79.4) 112 (86.2) 216 (86.7) 259 (87.2) 477 (87.5) Within community 382 (18.2) 774 (19.8) 382 (18.4) 800 (20.6) 18 (13.8) 33 (13.3) 38 (12.8) 68 (12.5) Mental health conditions‡ Alcohol use disorder 241 (11.5) 377 (9.6) 318 (15.3) 511 (13.2) 28 (21.5) 47 (18.9) 62 (20.9) 117 (21.5) Substance-related/addictive disorders§ 657 (31.3) 1136 (29.0) 997 (48.0) 1787 (46.1) 43 (33.1) 82 (32.9) 113 (38.0) 197 (36.1) Depression 61 (2.9) 101 (2.6) 96 (4.6) 175 (4.5) –** 9 (3.6) 11 (3.7) 19 (3.5) Anxiety 165 (7.9) 284 (7.3) 187 (9.0) 320 (8.3) –** 7 (2.8) 22 (7.4) 44 (8.1) Bipolar 10 (0.5) 16 (0.4) 13 (0.6) 23 (0.6) –** –** –** –** Schizophrenia spectrum disorder 35 (1.7) 46 (1.2) 45 (2.2) 89 (2.3) –** –** 7 (2.4) 7 (1.3) Trauma-/stressor-related disorders 38 (1.8) 60 (1.5) 49 (2.4) 94 (2.4) –** –** 6 (2.0) 8 (1.5) Comorbidity‡ ADGs total score, mean ± SD 4.3 ± 3.6 3.9 ± 3.4 5.3 ± 3.7 5.0 ± 3.6 6.7 ± 4.4 6.5 ± 4.1 7.5 ± 4.8 7.6 ± 4.7 ADGs total score, median (IQR) 4 (1–7) 3 (1–6) 5 (2–8) 4 (2–7) 7 (3–10) 6 (3–9) 7 (4–11) 7 (4–11) No. of ADGs categories¶ ≤ 3 668 (31.9) 1375 (35.1) 628 (30.2) 1284 (33.1) –** 54 (21.7) 62 (20.9) 95 (17.4) 4–7 702 (33.5) 1280 (32.7) 762 (36.7) 1440 (37.2) 41 (31.5) 97 (39.0) 85 (28.6) 164 (30.1) 8–10 251 (12.0) 392 (10.0) 350 (16.9) 578 (14.9) 23 (17.7) 40 (16.1) 52 (17.5) 97 (17.8) ≥ 11 132 (6.3) 193 (4.9) 203 (9.8) 310 (8.0) 29 (22.3) 47 (18.9) 87 (29.3) 163 (29.9) Nonuser/missing 343 (16.4) 676 (17.3) 134 (6.5) 263 (6.8) –** 11 (4.4) 11 (3.7) 26 (4.8) Note: ADGs = Aggregated Diagnosis Groups, HCV = hepatitis C virus, IQR = interquartile range, SD = standard deviation.
↵* Except where noted otherwise.
↵† Also included people who had an out-of-province residence code for the year of matching date.
↵‡ During the year before matching date.
↵§ Also contains records pertaining to alcohol use disorder.
↵¶ The frequencies associated with each specific ADGs category can be found in Appendix 5, Supplemental Table S7.
↵** Suppressed to remove risk of reidentification as per ICES privacy rules.
- Table 4:
Mean total health care costs per 30 days for case and control participants, by cost category and phase of care
Resource category Cohort; mean cost per 30 d, $* (% of total) Prediagnosis phase Initial phase Late phase Terminal phase Case Control Case Control Case Control Case Control Outpatient visits 62 (9.7) 31 (10.8) 89 (10.2) 70 (14.1) 227 (8.1) 240 (23.7) 667 (7.5) 738 (9.2) Physician services 130 (20.3) 76 (26.5) 168 (19.2) 110 (22.1) 405 (14.5) 151 (14.8) 1056 (11.9) 875 (10.9) Emergency department visits 77 (12.0) 27 (9.3) 55 (6.3) 40 (8.0) 173 (6.2) 57 (5.6) 249 (2.8) 271 (3.4) Same-day surgery 8 (1.3) 9 (3.1) 9 (1.0) 10 (2.0) 33 (1.2) 16 (1.6) 17 (0.2) 31 (0.4) Inpatient care 252 (39.6) 103 (35.5) 325 (37.2) 172 (34.7) 1307 (46.9) 332 (32.7) 5929 (66.6) 5261 (65.3) Outpatient prescription 33 (5.2) 18 (6.3) 150 (17.1) 47 (9.5) 405 (14.5) 105 (10.4) 215 (2.4) 201 (2.5) Laboratory tests/services 28 (4.4) 11 (3.7) 17 (1.9) 9 (1.9) 21 (0.8) 10 (1.0) 17 (0.2) 12 (0.1) Other services† 48 (7.5) 14 (4.9) 62 (7.1) 39 (7.8) 214 (7.7) 104 (10.3) 747 (8.4) 662 (8.2) Total 637 (100.0) 289 (100.0) 875 (100.0) 497 (100.0) 2786 (100.0) 1016 (100.0) 8896 (100.0) 8050 (100.0) Resource category Phase of care; mean net cost (95% CI) per 30 days, $* Prediagnosis phase Initial phase Late Terminal Outpatient visits 31 (12 to 54) 19 (−9 to 47) −14 (−190 to 166) −66 (−312 to 193) Physician services 53 (41 to 65) 58 (47 to 69) 255 (181 to 338) 182 (−34 to 448) Emergency department visits 50 (43 to 56) 15 (10 to 20) 116 (66 to 170) −22 (−77 to 30) Same-day surgery −1 (−4 to 3) −1 (−2 to 0) 17 (3 to 34) −14 (−31 to 1) Inpatient care 150 (106 to 202) 153 (97 to 219) 975 (621 to 1378) 696 (−975 to 2487) Outpatient prescription 15 (9 to 20) 102 (89 to 115) 300 (171 to 443) 14 (−73 to 120) Laboratory tests/services 17 (14 to 20) 8 (6 to 9) 11 (4 to 21) 5 (0 to 10) Other services 34 (7 to 65) 23 (−4 to 54) 109 (10 to 205) 85 (−198 to 389) Total 348 (277 to 427) 377 (288 to 470) 1768 (1153 to 2427) 893 (−1114 to 3149) Note: CI = confidence interval.
↵* Costs are rounded to the nearest dollar and expressed in 2018 Canadian dollars.
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