Sociodemographic correlates of 25-hydroxyvitamin D test utilization in Calgary, Alberta

BMC Health Services Research

Christopher Naugler³  Brenda R Hemmelgarn⁴  Paul Woods²  Dan Henne¹  Lawrence de Koning¹ 

[1] Calgary Laboratory Services, Calgary, AB, Canada;Department of Family Medicine, University of Calgary, Calgary, AB, Canada;C414, Diagnostic and Scientific Centre, 9, 3535 Research Road NW, T2L 2 K8 Calgary, AB, Canada;Department of Medicine, University of Calgary, Calgary, AB, Canada

关键词: Canada census data;    Laboratory utilization;    Vitamin D;   

Others  :  1126770
DOI  :  10.1186/1472-6963-14-339

 received in 2013-05-31, accepted in 2014-07-22,  发布年份 2014

【 摘 要 】

Background

Increasing laboratory test utilization is a major challenge facing clinical laboratories.

However, in most instances we lack population level information on the patient groups to which increased testing is directed. Much recent work has been published on the sociodemographic correlates of 25-hydroxyvitamin D deficiency. An unanswered question, however, is whether testing is preferentially directed towards individuals with a higher likelihood of deficiency. In this paper we examine this question by combining laboratory information system data on testing rates with Census Canada data.

Methods

We examined 1,436 census dissemination areas within the city of Calgary, Alberta, Canada. For each census dissemination area we determined age and sex-specific 25-hydroxyvitamin D testing rates over a one year period. We then compared these testing rates with the following sociodemographic variables obtained from Census Canada: first nations status, education level, household income, visible minority status, and recent immigrant status.

Results

Overall, 6.9% of males in the city of Calgary were tested during the study period. Females were 1.7 times more likely to be tested than males. Testing rate increased with increasing age, with 16.8% of individuals 66 years and over tested during the one-year study period.

Individuals having at least some university education were less likely to be tested (RR = 0.60;

p < 0.0001). Interestingly, although visible minorities were over twice as likely to be tested as compared to non-visual minorities (RR = 2.25; p < 0.0001), recent immigrants, a group known to exhibit low 25 hydroxyvitamin D levels, were significantly less likely to be tested than non-recent immigrants (RR = 0.72; p = 0.0174). While median household income was modestly associated with increased testing (RR = 1.02; p < 0.0001), First Nations status and non-English speaking were not significant predictors of 25-hydroxyvitamin D testing.

Conclusions

Testing for 25-hydroxyvitamin D is in part directed toward populations at higher risk of deficiency (visible minorities) and at higher risk of osteoporosis (older females), but a particularly high risk group (recent immigrants) is being tested at a lower rate than other patient groups.

【 授权许可】

   
2014 de Koning et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Bossuyt Y, Verweire K, Blanckaert N: Laboratory Medicine: challenges and opportunities. Clin Chem 2007, 53:1730-1733.
• [2]Lewandrowski K: Managing utilization of new diagnostic tests. Clin Leadersh Manag Rev 2003, 17:318-24.
• [3]Naugler C: A perspective on utilization management from Canada. Clin Chim Acta 2013. preprint ahead of publication, doi:10.1016/j.cca.2013.09.022
• [4]Huck A, Lewandrowski K: Utilization management in the clinical laboratory: an introduction and overview of the literature. Clin Chim Acta 2013. preprint ahead of publication, doi:10.1016/j.cca.2013.09.021
• [5]Plebani M, Zaninotto M, Faggian D: Utilization management: a European perspective. Clin Chim Acta 2013. preprint ahead of publication, doi:10.1016/j.cca.2013.03.002
• [6]Naugler C, Zhang J, Henne D, Woods P, Hemmelgarn BR: Association of vitamin D status with socio-demographic factors in Calgary, Alberta: an ecological study using Census Canada data. BMC Public Health 2013, 13:316.
• [7]Census Canada. [http://www12.statcan.gc.ca/nhs-enm/index-eng.cfm?HPA webcite]
• [8]Aucoin M, Weaver R, Thomas R, Jones L: Vitamin D status of refugees arriving in Canada. Can Fam Phys 2013, 59:e188-e194.
• [9]Langolois K, Greene-Finestone L, Little J, Hidiroglou N, Whiting S: Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey. Stat Can 2009, 2010(21):47-54.
• [10]Greene-Finestone LS, Berger C, de Groh M, Hanley DA, Hidiroglou N, Sarafin K, Poliquin S, Krieger J, Richards JB, Goltzman D, CaMos Research Group: 25-Hydroxyvitamin D in Canadian adults: biological, environmental, and behavioral correlates. Osteoporos Int 2011, 22:1389-1399.
• [11]Gozdzik A, Barta JL, Wu H, Wagner D, Cole DE, Vieth R, Whiting S, Parra EJ: Low wintertime vitamin D levels in a sample of healthy young adults of diverse ancestry living in the Toronto area: associations with vitamin D intake and skin pigmentation. BMC Public Health 2008, 8:336.
• [12]Vieth R, Cole DE, Hawker GA, Trang HM, Rubin LA: Wintertime vitamin D insufficiency is common in young Canadian women, and their vitamin D intake does not prevent it. Eur J Clin Nutr 2001, 55:1091-1097.
• [13]Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales-Torres J, IOF Committee of Scientific Advisors (CSA) Nutrition Working Group: Global vitamin D status and determinants of hypovitaminosis D. Osteoporosis Int 2009, 20:1807-1820.
• [14]Lebrun JB, Moffatt ME, Mundy RJ, Sangster RK, Postl BD, Dooley JP, Dilling LA, Godel JC, Haworth JC: Vitamin D deficiency in a Manitoba community. Can J Public Health 1993, 84:394-396.
• [15]Ward LM, Gaboury I, Ladhani M, Zlotkin S: Vitamin D-deficiency rickets among children in Canada. CMAJ 2007, 177:161-166.
• [16]Weiler HA, Leslie WD, Krahn J, Steiman PW, Metge CJ: Canadian Aboriginal women have a higher rate of vitamin D deficiency than non-Aboriginal women status despite similar dietary vitamin D intakes. J Nutr 2007, 137:461-465.
• [17]Jääskeläinen T, Knekt P, Marniemi J, Sares-Jäske L, Männistö S, Heliövaara M, Järvinen R: Vitamin D status is associated with sociodemographic factors, lifestyle and metabolic health. Eur J Nutr 2013, 52:513-525.
• [18]Hanley DA, Cranney A, Jones G, Whiting SJ, Leslie WD, Cole DEC, Atkinson SA, Josse RG, Feldman S, Kline GA, Rosen C, for the Guidelines Committee of the Scientific Advisory Council of Osteoporosis Canada: Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada. CMAJ 2010, 182:E610-E618 1.
• [19]Babitsch B, Gohl D, von Lengerke T: Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011. Psychosoc Med 2012, 9:Doc11.
• [20]Subban JE, Terwoord NA, Schuster RJ: With or without intent: how racial disparities prevent effective implementation of care. J Nutr Health Aging 2008, 12:770S-775S.
• [21]Guilfoyle J, Kelly L, St Pierre-Hansen N: Prejudice in medicine. Our role in creating health care disparities. Can Fam Phys 2008, 54:1511-1513.
• [22]Thomas SB: The color line: race matters in the elimination of health disparities. Am J Public Health 2001, 91:1046-1048.
• [23]Raphael D: Social determinants of health: present status, unanswered questions, and future dire3ctions. Int J Health Serv 2006, 36:651-677.
• [24]Fuller-Thomson E, Noack AM, George U: Health decline among recent immigrants to Canada: findings from a nationally-representative longitudinal survey. Can J Public Health 2011, 102:273-280.
• [25]Gushulak BD, Pottie K, Hatcher Roberts J, Torres S, DesMeules M, Canadian Collaboration for Immigrant and Refugee Health: Migration and health in Canada: health in the global village. CMAJ 2011, 183:E952-958.
• [26]Leduc N, Proulx M: Patterns of health services utilization by recent immigrants. J Immigr Health 2004, 6:15-27.
• [27]Bissonnette L, Wilson K, Bell S, Shah TI: Neighbourhoods and potential access to health care: the role of spatial and aspatial factors. Health Place 2012, 18:841-853.
• [28]Woltman KJ, Newbold KB: Immigrant women and cervical cancer screening uptake: a multilevel analysis. Can J Public Health 2007, 98:470-475.
• [29]Vatanparast V, Adolphe JL, Whiting SJ: Socio-economic status and vitamin/mineral supplement use in Canada. Health Rep 2010, 21:19-25.
• [30]Rock CL: Multivitamin-multimineral supplements: who uses them? Am J Clin Nutr 2007, 85:277s-279s.
• [31]van Walraven C, Goel V, Austin P: Why are investigations not recommended by practice guidelines ordered at the periodic health examination? J Eval Clin Pract 2000, 6(2):215-24.