Some patients with back pain contribute disproportionately to high healthcare costs; however, characteristics of high-cost users with back pain are not well defined. We described high-cost healthcare users based on total costs among a population-based cohort of adults with back pain within the Ontario government's single-payer health system across sociodemographic, health, and behavioural characteristics. We conducted a population-based cohort study of Ontario adult (aged 18 years or older) respondents of the Canadian Community Health Survey (CCHS) with back pain (2003-2012), linked to administrative data (n = 36,605; weighted n = 2,076,937, representative of Ontario). Respondents were ranked based on gradients of total healthcare costs (top 1%, top 2%-5%, top 6%-50%, and bottom 50%) for 1 year following the CCHS survey, with high-cost users as top 5%. We used multinomial logistic regression to investigate characteristics associated with the 4 cost groups. Top 5% of cost users accounted for 49% ($4 billion CAD) of total healthcare spending, with inpatient hospital care as the largest contributing service type (approximately 40% of costs). Top 5% high-cost users were more likely aged 65 years or older (ORtop1% = 16.6; ORtop2-5% = 44.2), with lower income (ORtop1% = 3.6; ORtop 2-5% = 1.8), chronic disease(s) (ORtop1% = 3.8; ORtop2-5% = 1.6), Aggregated Diagnosis Groups measuring comorbidities (ORtop1% = 25.4; ORtop2-5% = 13.9), and fair/poor self-rated general health (ORtop1% = 6.7; ORtop2-5% = 4.6) compared with bottom 50% users. High-cost users tended to be current/former smokers, obese, and report fair/poor mental health. High-cost users (based on total costs) among adults with back pain account for nearly half of all healthcare spending over a 1-year period and are associated with older age, lower income, comorbidities, and fair/poor general health. Findings identify characteristics associated with a high-risk group for back pain to inform healthcare and public health strategies that target upstream determinants.

中文翻译：

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加拿大安大略省患有背痛的成年人中高成本医疗保健使用者的特征：一项基于人群的队列研究。

一些背痛患者要承担高昂的医疗费用；然而，患有背痛的高成本用户的特征尚未明确定义。我们根据安大略省政府单一付款人医疗系统中背痛成年人群体的总成本，描述了高成本医疗保健用户的社会人口、健康和行为特征。我们对加拿大社区健康调查 (CCHS) 中患有背痛的安大略省成人（18 岁或以上）受访者（2003-2012 年）进行了一项基于人群的队列研究，并与行政数据相关联（n = 36,605；加权 n = 2,076,937） ，安大略省代表）。CCHS 调查后一年内，根据总医疗费用梯度（前 1%、前 2%-5%、前 6%-50% 和后 50%）对受访者进行排名，其中高费用用户排名前 5 位%。我们使用多项逻辑回归来研究与 4 个成本组相关的特征。前 5% 的成本用户占医疗保健总支出的 49%（40 亿加元），其中住院护理是贡献最大的服务类型（约占成本的 40%）。前 5% 的高费用用户更有可能年龄在 65 岁或以上（ORtop1% = 16.6；ORtop2-5% = 44.2），收入较低（ORtop1% = 3.6；ORtop 2-5% = 1.8），患有慢性疾病（ s) (ORtop1% = 3.8; ORtop2-5% = 1.6)，测量合并症的综合诊断组 (ORtop1% = 25.4; ORtop2-5% = 13.9)，以及一般健康状况自评一般/较差 (ORtop1% = 6.7; ORtop2-5% = 4.6) 与排名后 50% 的用户相比。高成本用户往往是当前/以前的吸烟者、肥胖者，并且心理健康状况一般/较差。患有背痛的成年人中的高成本用户（基于总成本）占一年内所有医疗保健支出的近一半，并且与年龄较大、收入较低、合并症和总体健康状况一般/较差有关。研究结果确定了与背痛高危人群相关的特征，为针对上游决定因素的医疗保健和公共卫生策略提供信息。