Associations of multimorbidity and income with hospital admission were investigated in population samples from 3 widely differing health care systems: Scotland (n = 36,921), China (n = 162,464), and Hong Kong (n = 29,187). Multimorbidity increased odds of admissions in all 3 settings. In Scotland, poorer people were more likely to be admitted (adjusted odds ratio [aOR] = 1.62; 95% CI, 1.41-1.86 for the lowest income group vs the highest), whereas China showed the opposite (aOR = 0.58; 95% CI, 0.56-0.60). In Hong Kong, poorer people were more likely to be admitted to public hospitals (aOR = 1.68; 95% CI, 1.36-2.07), but less likely to be admitted to private ones (aOR = 0.18; 95% CI, 0.13-0.25). Strategies to improve equitable health care should consider the impact of socioeconomic deprivation on the use of health care resources, particularly among populations with prevalent multimorbidity. 2015;13:164-167. doi: 10.1370/afm.1757.
Ann Fam Med
INTRODUCTIONM ultimorbidity, the coexistence of 2 or more chronic conditions within an individual, is increasingly common 1,2 and leads to more hospital admissions, especially in patients having lower socioeconomic status.3 Most studies on multimorbidity have been conducted in developed countries in the West, however 4 ; how admission rates are influenced by socioeconomic status under differently organized and funded health care systems in eastern or transitioning countries is unknown.Scotland, a western country, has a well-established public health care system providing universal coverage. Work there has shown a clear link between low socioeconomic status, multimorbidity, and admission rates. China, the largest country in the world in transition, does not provide universal health coverage. Social medical insurance offers a limited benefits package, and most health care remains based on fee-for-service charges and patients' private out-of-pocket payment.5 Hong Kong, however, has maintained a public health care sector, funded mainly by taxes and providing the majority of secondary care, while the sizeable private health care sector, funded on a fee-for-service basis underpinned by direct out-ofpocket expenditure, provides the majority of primary care. We thus aimed to examine the relationships of multimorbidity and income with hospital admission in representative samples from these 3 countries.
METHODSWe undertook a cross-sectional comparative study from large, representative population-based surveys using multistage stratified random sampling in Scotland, 6 China, 2 and Hong Kong.
165(n = 36,921) of the population with response rates ranging from 67% to 81%. 6 The study sample in China included 4.55% (n = 162,464) of the general resident population in 3 representative prefectures (with health care and population characteristics comparable to national average) 2 in Guangdong province. The household replacement rate was 9.91%, and 14.46% of questionnaires were answered by householders on behalf of household members.2 Data in Hong Kong came from the 2011 Thematic Househo...
