Effects of geodemographic profiles on healthcare service utilization: a case study on cardiac care in Ontario, Canada

BACKGROUND Although literature has associated geodemographic factors with healthcare service utilization, little is known about how these factors - such as population size, age profile, service accessibility, and educational profile - interact to influence service utilization. This study fills this gap in the literature by examining both the direct and the moderating effects of geodemographic profiles on the utilization of cardiac surgery services. METHODS We aggregated secondary data obtained from Statistics Canada and Cardiac Care Network of Ontario to derive the geodemographic profiles of Ontario and the corresponding cardiac surgery service utilization in the years between 2004 and 2007. We conducted a two-step test using Partial Least Squares-based structural equation modeling to investigate the relationships between geodemographic profiles and healthcare service utilization. RESULTS Population size and age profile have direct positive effects on service utilization (β = 0.737, p < 0.01; β = 0.284, p < 0.01, respectively), whereas service accessibility is negatively associated with service utilization (β = -0.210, p < 0.01). Service accessibility decreases the effect of population size on service utilization (β = -0.606, p < 0.01), and educational profile weakens the effects of population size and age profile on service utilization (β = -0.595, p < 0.01; β = -0.286, p < 0.01, respectively). CONCLUSIONS In this study, we found that (1) service accessibility has a moderating effect on the relationship between population size and service utilization, and (2) educational profile has moderating effects on both the relationship between population size and service utilization, and the relationship between age profile and service utilization. Our findings suggest that reducing regional disparities in healthcare service utilization should take into account the interaction of geodemographic factors such as service accessibility and education. In addition, the allocation of resources for a particular healthcare service in one area should consider the geographic distribution of the same services in neighboring areas, as patients may be willing to utilize these services in areas not far from where they reside.