Aging
Socioeconomic and Gender-Based Disparities in Admissions to Long-Term Care Facilities in Quebec, Canada Clara Bolster-Foucault* Clara Bolster-Foucault Isabelle Vedel Nadia Sourial Claire Godard-Sebillotte Amélie Quesnel-Vallée
An overwhelming majority of older adults wish to remain in their homes and communities as they age. Despite the near-universal preference for aging in place, health inequities across the lifespan and gaps in publicly-funded home- and community-based services to support aging in place may create disparities in the ability to do so. Our objective was to examine socioeconomic and gender-based inequities in the age at long-term care (LTC) admissions in Quebec.
Using the TorSaDE Cohort, which contains linked Canadian Community Health Survey data from 2007-2016 and longitudinal provincial health administrative data from 1996-2016, we created a representative sample of community-dwelling Quebec residents aged 65 and older (n=24,269). We used Cox proportional hazards models to measure disparities in the hazard of admission to LTC by educational attainment (having a high school diploma or not) and gender, modelling intersectional effects using statistical interaction. We used the Fine-Gray subdistribution hazard approach to account for competing risk of death and accounted for time-fixed (self-rated health, racialization, rurality, marital status, household size) and time-varying (age, comorbidity score) covariates.
The average length of follow-up was 4.25 years. Among men, lower educational attainment was associated with a higher rate of admission to LTC (sHR=1.34, 95%CI: 1.12-1.60). However, among women, lower educational attainment was associated with a lower rate of admission to LTC (sHR=0.82, 95%CI: 0.65-1.04). Among older adults with higher educational attainment, women were at a higher rate of admission to LTC than men (sHR=1.22, 95%CI: 1.02-1.46).
Our results reveal meaningful socioeconomic and gender-based disparities in admissions to LTC among older adults in Quebec. The effect of education differs qualitatively among men and women, indicating an important intersectional effect. These results can inform efforts to equitably support aging in place.