Epidemiology and health care utilization associated with chronic pain in Newfoundland and Labrador, Canada: a population-based study using health administrative data

Foley, Heather Elizabeth (2021) Epidemiology and health care utilization associated with chronic pain in Newfoundland and Labrador, Canada: a population-based study using health administrative data. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Background: Chronic pain exerts a tremendous burden on individuals, families, and society, and has a high estimated prevalence (up to 54% globally and 44% in Canada) and direct health care cost ($7.2 billion in Canada in 2014). Most Canadian epidemiological and cost estimates do not include Newfoundland and Labrador; a knowledge gap potentially filled using health administrative data. Aim: To extract information about chronic pain as a single chronic disease in Newfoundland and Labrador using health administrative data. Methods: Health administrative data algorithms that identify cases of chronic pain as a single chronic disease were derived from the Newfoundland and Labrador Medical Care Plan Fee-for-Service Physician Claims File and Provincial Discharge Abstract Data of known chronic pain populations, and validated against an audit of the electronic medical records data of a primary care population sample. The most performant algorithm was used to identify chronic pain cases from fee-for-service physician claims data in Newfoundland and Labrador, which allowed estimation of both chronic pain incidence/prevalence, and chronic pain association with comorbidity presence and annual health care utilization. Results: The most performant validated algorithm to ascertain chronic pain cases from Newfoundland and Labrador administrative data had 70.3% sensitivity, 66.8% specificity, and 40.3% positive predictive value. As defined by the algorithm, the 2009/10 age-standardized Newfoundland and Labrador chronic pain prevalence was estimated at 37,469 per 100,000 population and incidence rate was estimated at 4,585 per 100,000 person-years at risk. Estimates were higher in females, residents of urban areas, and with increasing age. Residents identified as chronic pain cases had two to four times the odds of having a chronic comorbidity and up to twice the rate of publicly funded health care utilization compared to residents not identified as chronic pain cases. Conclusions: A health administrative data algorithm was derived and validated to identify chronic pain cases and estimate disease burden in residents attending fee-for-service physician encounters in Newfoundland and Labrador. The Chronic Pain Algorithm identified almost four out of ten Newfoundland and Labrador residents and they had a higher prevalence of comorbidities and utilization of publicly funded health services.

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