TY - JOUR
AU - A. Toulany
AU - P. Kurdyak
AU - T. A. Stukel
AU - R. Strauss
AU - L. Fu
AU - J. Guan
AU - L. Fiksenbaum
AU - E. Cohen
AU - A. Guttmann
AU - S. Vigod
AU - M. Chiu
AU - Moore Hepburn
AU - K. Moran
AU - W. Gardner
AU - M. Cappelli
AU - P. Sundar
AU - N. Saunders
A1 - 
AB - OBJECTIVE: We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic. METHODS: This population-based repeated cross-sectional study of children and adolescents (3-17 years; N = 2.5 million) used linked health and demographic administrative data in Ontario, Canada (2017-2021). Multivariable Poisson regressions with generalized estimating equations compared rates of outpatient physician-based mental healthcare use during the first year of the COVID-19 pandemic with expected rates based on pre-COVID patterns. Analyses were conducted by socioeconomic status (material deprivation quintiles of the Ontario Marginalization index), urban/rural region of residence, and immigration status. RESULTS: Overall, pediatric physician-based mental healthcare visits were 5% lower than expected (rate ratio [RR] = 0.95, 95% confidence interval [CI], 0.92 to 0.98) among those living in the most deprived areas in the first year of the pandemic, compared with the least deprived with 4% higher than expected rates (RR = 1.04, 95% CI, 1.02 to 1.06). There were no differences in overall observed and expected visit rates by region of residence. Immigrants had 14% to 26% higher visit rates compared with expected from July 2020 to February 2021, whereas refugees had similarly observed and expected rates. Virtual care use was approximately 65% among refugees, compared with 70% for all strata. CONCLUSION: During the first year of the pandemic, pediatric physician-based mental healthcare utilization was higher among immigrants and lower than expected among those with lower socioeconomic status. Refugees had the lowest use of virtual care. Further work is needed to understand whether these differences reflect issues in access to care or the need to help inform ongoing pandemic recovery planning.
AD - The Hospital for Sick Children, Toronto, Canada.; Department of Pediatrics, University of Toronto, Toronto, Canada.; ICES, Toronto, Canada.; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.; Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada.; Centre for Addiction and Mental Health, Toronto, Canada.; Women's College Hospital and Women's College Research Institute, Toronto, Canada.; Children's Mental Health Ontario, Toronto, Canada.; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.; Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada.
AN - 36855797
BT - Can J Psychiatry
C5 - Healthcare Disparities; HIT & Telehealth; Financing & Sustainability
CP - 12
DA - Dec
DO - 10.1177/07067437231156254
DP - NLM
ET - 20230228
IS - 12
JF - Can J Psychiatry
LA - eng
N2 - OBJECTIVE: We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic. METHODS: This population-based repeated cross-sectional study of children and adolescents (3-17 years; N = 2.5 million) used linked health and demographic administrative data in Ontario, Canada (2017-2021). Multivariable Poisson regressions with generalized estimating equations compared rates of outpatient physician-based mental healthcare use during the first year of the COVID-19 pandemic with expected rates based on pre-COVID patterns. Analyses were conducted by socioeconomic status (material deprivation quintiles of the Ontario Marginalization index), urban/rural region of residence, and immigration status. RESULTS: Overall, pediatric physician-based mental healthcare visits were 5% lower than expected (rate ratio [RR] = 0.95, 95% confidence interval [CI], 0.92 to 0.98) among those living in the most deprived areas in the first year of the pandemic, compared with the least deprived with 4% higher than expected rates (RR = 1.04, 95% CI, 1.02 to 1.06). There were no differences in overall observed and expected visit rates by region of residence. Immigrants had 14% to 26% higher visit rates compared with expected from July 2020 to February 2021, whereas refugees had similarly observed and expected rates. Virtual care use was approximately 65% among refugees, compared with 70% for all strata. CONCLUSION: During the first year of the pandemic, pediatric physician-based mental healthcare utilization was higher among immigrants and lower than expected among those with lower socioeconomic status. Refugees had the lowest use of virtual care. Further work is needed to understand whether these differences reflect issues in access to care or the need to help inform ongoing pandemic recovery planning.
PY - 2023
SN - 0706-7437 (Print); 0706-7437
SP - 904
EP - 915+
ST - Sociodemographic Differences in Physician-Based Mental Health and Virtual Care Utilization and Uptake of Virtual Care Among Children and Adolescents During the COVID-19 Pandemic in Ontario, Canada: A Population-Based Study
T1 - Sociodemographic Differences in Physician-Based Mental Health and Virtual Care Utilization and Uptake of Virtual Care Among Children and Adolescents During the COVID-19 Pandemic in Ontario, Canada: A Population-Based Study
T2 - Can J Psychiatry
TI - Sociodemographic Differences in Physician-Based Mental Health and Virtual Care Utilization and Uptake of Virtual Care Among Children and Adolescents During the COVID-19 Pandemic in Ontario, Canada: A Population-Based Study
U1 - Healthcare Disparities; HIT & Telehealth; Financing & Sustainability
U3 - 10.1177/07067437231156254
VL - 68
VO - 0706-7437 (Print); 0706-7437
Y1 - 2023
ER -