Unadjusted and adjusted risk of prolonged surgical wait times for cataract and benign uterine surgery, according to neighbourhood marginalization measures and patient and hospital factors*†
| Patient characteristic‡ | Cataract surgery | Benign uterine surgery§ | ||
|---|---|---|---|---|
| OR (95% CI) | Adjusted OR¶ (95% CI) | OR (95% CI) | Adjusted OR¶ (95% CI) | |
| Age, yr (ref. 40) | ||||
| 50 | 1.10 (1.07–1.14) | 1.10 (1.06–1.14) | 0.94 (0.92–0.96) | 0.90 (0.89–0.92) |
| 60 | 1.33 (1.27–1.40) | 1.33 (1.26–1.40) | 0.75 (0.72–0.79) | 0.68 (0.65–0.71) |
| 70 | 1.61 (1.52–1.70) | 1.62 (1.54–1.72) | 0.61 (0.57–0.64) | 0.51 (0.48–0.55) |
| 80 | 1.79 (1.70–1.89) | 1.83 (1.73–1.94) | 0.57 (0.52–0.63) | 0.48 (0.43–0.53) |
| Comorbidity score (per 5-unit increase)** | 0.99 (0.98–1.00) | 0.97 (0.96–0.98) | 0.97 (0.94–1.00) | 1.01 (0.98–1.05) |
| Priority level (ref. (4)) | ||||
| Priority | 3 2.65 (2.56–2.74) | 2.85 (2.75–2.95) | 3.99 (3.85–4.13) | 4.72 (4.55–4.90) |
| Sex (ref. male) | ||||
| Female | 1.13 (1.12–1.15) | 1.14 (1.12–1.16) | – | 0.85 (0.79–0.91) |
| Rural (ref. non-rural)†† | 1.33 (1.27–1.38) | 1.30 (1.24–1.37) | 1.00 (0.94–1.07) | 1.67 (1.56–1.80) |
| Region (ref. Toronto) | ||||
| Eastern | 1.55 (1.49–1.61) | 1.59 (1.51–1.68) | 1.63 (1.53–1.73) | 1.47 (1.38–1.56) |
| GTHA | 1.08 (1.04–1.12) | 1.06 (1.01–1.10) | 1.13 (1.06–1.19) | 2.08 (1.93–2.25) |
| Western | 1.63 (1.57–1.70) | 1.67 (1.59–1.75) | 1.22 (1.15–1.30) | 4.47 (4.08–4.90) |
| Northern | 0.98 (0.93–1.04) | 1.04 (0.97–1.12) | 3.30 (3.05–3.56) | 1.01 (0.98–1.05) |
| Hospital type (ref. non-teaching)‡‡ | ||||
| Teaching | 0.94 (0.92–0.97) | 0.85 (0.82–0.88) | 1.90 (1.83–1.98) | 2.19 (2.11–2.28) |
| Year (ref. 2013) | ||||
| 2014 | 1.10 (1.06–1.15) | 1.12 (1.08–1.16) | 0.92 (0.86–0.98) | 2.19 (2.11–2.28) |
| 2015 | 1.48 (1.42–1.54) | 1.53 (1.47–1.59) | 0.93 (0.88–0.99) | 0.90 (0.85–0.96) |
| 2016 | 2.10 (2.01–2.19) | 2.21 (2.12–2.30) | 0.95 (0.89–1.01) | 0.95 (0.89–1.01) |
| 2017 | 2.40 (2.30–2.50) | 2.55 (2.45–2.66) | 0.96 (0.91–1.02) | 1.00 (0.94–1.07) |
| 2018 | 2.29 (2.20–2.39) | 2.38 (2.28–2.48) | 0.88 (0.83–0.94) | 1.04 (0.98–1.11) |
| 2019 | 2.15 (2.06–2.24) | 2.20 (2.11–2.29) | 0.85 (0.79–0.90) | 0.96 (0.90–1.03) |
| Dependency quintile | ||||
| 2 | 0.95 (0.92–0.99) | 0.93 (0.89–0.96) | 0.98 (0.93–1.04) | 1.01 (0.96–1.07) |
| 3 | 0.91 (0.88–0.94) | 0.88 (0.84–0.91) | 0.98 (0.93–1.04) | 1.01 (0.95–1.07) |
| 4 | 0.88 (0.84–0.91) | 0.82 (0.79–0.85) | 0.93 (0.88–0.99) | 1.00 (0.94–1.06) |
| 5 | 0.92 (0.89–0.95) | 0.81 (0.78–0.85) | 0.87 (0.82–0.92) | 0.98 (0.92–1.04) |
| Deprivation quintile | ||||
| 2 | 0.94 (0.91–0.97) | 0.93 (0.90–0.96) | 1.00 (0.95–1.06) | 1.01 (0.96–1.07) |
| 3 | 0.92 (0.89–0.95) | 0.90 (0.87–0.93) | 1.03 (0.97–1.09) | 1.06 (1.00–1.13) |
| 4 | 0.87 (0.84–0.90) | 0.84 (0.81–0.87) | 1.07 (1.01–1.13) | 1.10 (1.03–1.17) |
| 5 | 0.82 (0.79–0.86) | 0.77 (0.74–0.81) | 1.06 (1.00–1.12) | 1.04 (0.98–1.12) |
| Instability quintile | ||||
| 2 | 0.96 (0.93–0.99) | 0.97 (0.93–1.00) | 0.95 (0.90–1.01) | 0.99 (0.94–1.05) |
| 3 | 0.96 (0.93–0.99) | 0.98 (0.95–1.02) | 0.91 (0.86–0.96) | 0.96 (0.90–1.02) |
| 4 | 1.00 (0.96–1.03) | 1.08 (1.04–1.13) | 0.92 (0.87–0.97) | 0.95 (0.89–1.01) |
| 5 | 1.02 (0.98–1.06) | 1.16 (1.11–1.21) | 0.94 (0.89–1.00) | 0.91 (0.85–0.98) |
| Visible minority quintile | ||||
| 2 | 0.92 (0.88–0.96) | 0.96 (0.91–1.01) | 0.99 (0.93–1.06) | 0.92 (0.86–0.98) |
| 3 | 0.96 (0.92–1.00) | 1.05 (1.00–1.11) | 1.20 (1.12–1.28) | 1.09 (1.01–1.17) |
| 4 | 0.98 (0.94–1.02) | 1.06 (1.00–1.13) | 1.22 (1.14–1.30) | 1.10 (1.01–1.19) |
| 5 | 0.77 (0.74–0.81) | 0.83 (0.78–0.89) | 1.47 (1.37–1.57) | 1.28 (1.17–1.40) |
| Recent immigration | ||||
| 2 | 1.00 (0.97–1.03) | 1.04 (1.00–1.09) | 1.10 (1.04–1.15) | 1.00 (0.95–1.06) |
| 3 | 1.00 (0.97–1.04) | 1.12 (1.07–1.18) | 1.24 (1.17–1.30) | 1.09 (1.02–1.17) |
Note: CI = confidence interval, GTHA = Greater Toronto and Hamilton Area, OR = odds ratio.
↵* Unless otherwise stated, the reference group for presented odds ratios is quintile 1.
↵† The Wait Time Information System classifies procedure priority level. Level 1 is the most urgent, requiring immediate transfer to the operating room. This is followed by levels 2, 3 and 4, requiring urgent, semi-urgent and elective surgical intervention. The target wait time for level 3 is 84 days or fewer, and for level 4, 182 days or fewer.
↵‡ Levels of marginalization was categorized by ranking all dissemination areas in Ontario within each domain (or sub-domain) and assigned to a quintile, with quintile 1 representing the dissemination area with the lowest marginalization and quintile 5 (or quintile 3 in the case of “immigrated last 5 years”) the highest.
↵§ Benign uterine disease requiring surgical treatment consists of a mixture of hysterectomy (28%), hysteroscopic endometrial ablation (16%) and other benign diseases (56%). “Other benign diseases” is primarily composed of resection of endometrial polyps, myomectomy and adhesion lysis.
↵¶ Adjusted odds ratios were calculated by adjusting for all the variables in the table.
↵** Comorbidity score category: sum of Aggregated Diagnosis Groups. Estimated using Aggregated Diagnosis Groups calculated with The Johns Hopkins ACG System Version 10 software, based on subjects’ health care utilization records in the Discharge Abstract Database, Same Day Surgery Database and Ontario Health Insurance Plan database.
↵†† Rural residence includes residences in all territories lying outside population centres with > 10 000 residents. Regions defined as per Canada Post Corporation.
↵‡‡ Teaching Status: teaching hospitals are those classified as Group A under the Public Hospitals Act. (13)