Healthcare utilization and HIV burden among Black communities in Ontario: a matched cohort study

To describe the demographic and health profiles of Black people in the African Caribbean Track Study (A/C Study) who consented to linkage to administrative databases, examine variations in healthcare use, and compare these patterns to those observed in the general population to inform efforts to reduce health disparities.

Using a matched cohort design, participants who consented to administrative data linkage in the A/C Study were matched 1:10 to general population controls based on age (± 5 years), sex, and census metropolitan area. We compared sociodemographic characteristics, HIV prevalence, and healthcare use using descriptive statistics and logistic regression.

Of the 1380 A/C Study participants, 309 provided consent and 115 (8.3%) were successfully linked to administrative data and matched to 1150 controls (total N = 1265). A/C Study participants were significantly more likely to reside in areas of higher material deprivation and residential instability. HIV prevalence was substantially higher in the A/C cohort compared to the general population (OR = 29.87; 95% CI, 8.10-110.12). A/C participants also had significantly higher odds of ER use (OR = 2.16; 95% CI, 1.38-3.40). No significant differences were observed in primary care visits, hospitalizations, specialist visits, or UPC index.

This study highlights disparities in HIV burden and emergency care use among Black communities in Ontario, underscoring persistent inequities in access to timely, preventive care. These findings demonstrate the value of data linkage for equity-focused health system research and emphasize the need for culturally responsive interventions to improve outcomes among Black populations in Canada.