A Meta‐Analysis of Sex‐Based Differences in Health Service Use for Persons Living With Dementia Between 2018 and 2020 in Four Canadian Provinces
Bibliographic record
Abstract
BACKGROUND: Ensuring equitable healthcare services for persons with dementia is of utmost importance. Recent evidence points to sex-based differences in healthcare use in this population. However, available evidence is based on data from limited geographic regions and predates the COVID-19 pandemic, which is said to have further magnified disparities. This study aims to estimate sex-based differences in ambulatory and acute care service use in persons with dementia in four Canadian provinces between 2018 and 2020. METHODS: A retrospective multicohort design was conducted using linked health administrative data from Quebec, Ontario, Alberta, and Saskatchewan. Three cohorts (2018, 2019, and 2020) of community-dwelling persons aged 65 and older with dementia were identified. Within each cohort, rates of sex-stratified outcomes were calculated (per 10,000 person-years). The outcomes were visits to family physicians, cognitive specialists, other specialists, all-cause emergency departments, and all-cause hospitalizations. Estimates of the incidence rate difference (IRD) between males and females within each cohort year for each outcome were pooled using random-effect meta-analysis. RESULTS: The 2018, 2019, and 2020 cohorts included 97,811, 100,316, and 103,638 females, respectively. Similarly, 64,628, 67,013, and 69,839 males were included in the same respective cohorts. We found sex differences in ambulatory and acute care use in all three cohorts. Compared to females, males with dementia had higher rates of other specialists' visits, emergency department visits, and all-cause hospitalizations, with significant IRDs during the three cohort years. CONCLUSION: Consistent sex differences in healthcare use by persons with dementia were observed before and during the pandemic in four Canadian provinces, especially in acute care. This emphasizes the need to address sex-based differences in dementia care, ultimately working toward ensuring equitable and tailored healthcare services to enhance the quality of care and experiences for all persons with dementia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.024 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.042 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".