Community Characteristics and MAiD Uptake in Ontario: An Ecological Study
Michaela Kelly, MSc
Ellen Wiebe, MD, University of British Columbia, Department of Family Practice
Background: MAiD accounts for 2.0% of deaths in Canada, but uptake varies widely across the country. Little research has been done to identify community characteristics that contribute to the differences in MAiD uptake. Objectives: To investigate the relationship between community characteristics and MAiD uptake in order to provide insight for service planning in jurisdictions with new MAiD laws. Methods: This was an ecological study comparing population-level data from each Local Health Integration Network (LHIN). The number of MAiD deaths as a proportion of total deaths was calculated with data from the Office of the Chief Coroner in Ontario. Proportion over 65-years-old, proportion with a university degree, proportion of immigrants, proportion with English as a mother tongue, population density and median income were calculated using 2016 Census data. Proportion of decedents that accessed palliative care and the ratio of MAiD providers to decedents were calculated with data from published reports and presentations. Data was collected for each LHIN and compared. A correlation coefficient was calculated for each community characteristic to quantify its linear relationship to the uptake of MAiD. Linear regression was used to further analyze these relationships. Results: MAiD uptake ranged from 0.9 to 3.8%. After accounting for potential confounding effects, the proportion over 65 years old, the proportion of mother tongue English-speakers, the proportion of immigrants, and the number of MAiD providers per 1000 decedents were most strongly associated with MAiD uptake. Only having an older population was associated with MAiD uptake at a statistically significant level (p<0.05). On average, for every 1% increase in the proportion of population over 65 years, MAiD deaths accounted for 0.33% more of total deaths (95% CI: 0.07 to 0.58; p=0.02). Conclusions: These findings suggest that in addition to individual-level factors identified in previous literature, some community characteristics may also impact the uptake of MAiD.
Submission: July 18, 2021 | Publication: August 16, 2021
DISCLOSURES: The authors have no potential conflicts of interest to declare.
ATTRIBUTIONS: This project was conceived by MK and EW. MK gathered the data, and both authors analyzed the data and wrote and edited the manuscript.
CITATION: Kelly, M and Wiebe, E (2021). Community Characteristics and MAiD Uptake in Ontario: An Ecological Study. Canadian Health Policy, August 2021. ISSN 2562-9492 www.canadianhealthpolicy.com