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A small fraction of the population accounts for a disproportionate share of health care spending and resources. Linking data from health surveys with hospital and death records offers an opportunity to examine high use of acute care in more depth than is possible with administrative data alone.

Data and methods

Data for 62,675 respondents to three cycles of the Canadian Community Health Survey were linked to the Discharge Abstract Database and the Canadian Mortality Database. Respondents were categorized according to cumulative annual days in hospital: high users (30 days or more), non-high users (1 to 29), or not hospitalized. Cross-tabulations stratified by age (50 to 74 and 75 or older) were used to describe the socio-demographic, health, health behaviour, and hospital experience characteristics of the three groups. Multinomial logit and logistic regression were used to examine associations between these characteristics and high use or no hospitalization versus non-high use.


High users made up 0.5% of the population aged 50 to 74 and 2.6% of those aged 75 or older, but they accounted for 45.6% and 56.1%, respectively, of the days that people of these ages spent in hospital. Not having a partner, being at the end of life, having a neurological condition, as well as inactivity and comorbidity (ages 50 to 74) increased the odds of high use. Being female, not having major chronic conditions, not being at the end of life, normal/overweight, and being active were associated with no hospitalization.


Linking survey, hospital, and death data improves understanding of factors associated with high hospital use.


Data linkage, health survey, hospital costs, hospital records, hospitalization, length of stay, mortality, vital statistics


Health care spending amounted to an estimated $218 billion in 2016 and represented more than 11% of Canada’s Gross Domestic Product. A small percentage of the population (1% to 5%) accounts for a large share of these health care costs and resource use. [Full Text]


Michelle Rotermann (Michelle.Rotermann@canada.ca) is with the Health Analysis Division at Statistics Canada, Ottawa, Ontario, K1A 0T6.

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What is already known on this subject?

  • High users are a small fraction of the population, but they account for a disproportionate share of total health expenditures and resources.
  • Hospital administrative data show that high use tends to be associated with advancing age, chronic disease, and mobility impairment.
  • Less is known about factors not available in hospital data, such as end of life, marital status, weight, and inactivity.
  • Most Canadian studies of hospital use pertain to individual provinces.

What does this study add?

  • Linking survey and hospital administrative data yielded a large national database with which to study high use of acute care hospital services at age 50 or older.
  • A neurological condition, non-zero Charlson score (ages 50 to 74), discharge to long-term care, end of life, inactivity and not having a partner increased the odds of high use versus non-high use.
  • Being female, normal or overweight, physically active, not having several major diseases, and not being at the end of life were associated with no hospitalization versus being a non-high user.

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