Impact of socio-economic status on hospital length of stay following injury: a multicenter cohort study

Abstract

BackgroundInjury is second only to cardiovascular disease in terms of acute care costs in North America. One key to improving injury care efficiency is to generate knowledge on the determinants of resource use. Socio-economic status (SES) is a documented risk factor for injury severity and mortality but its impact on length of stay (LOS) for injury admissions is unknown. This study aimed to examine the relationship between SES and LOS following injury.This multicenter retrospective cohort study was based on adults discharged alive from any trauma center (2007–2012; 57 hospitals; 65,486 patients) in a Canadian integrated provincial trauma system. SES was determined using ecological indices of material and social deprivation. Mean differences in LOS adjusted for age, gender, comorbidities, and injury severity were generated using multivariate linear regression.ResultsMean LOS was 13.5 days. Patients in the highest quintile of material/social deprivation had a mean LOS 0.5 days (95 % CI 0.1-0.9)/1.4 days (1.1-1.8) longer than those in the lowest quintile. Patients in the highest quintiles of both social and material deprivation had a mean LOS 2.6 days (1.8-3.5) longer than those in the lowest quintiles.ConclusionsResults suggest that patients admitted for traumatic injury who suffer from high social and/or material deprivation have longer acute care LOS in a universal-access health care system. The reasons behind observed differences need to be further explored but may indicate that discharge planning should take patient SES into consideration.

Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database

“…With regard to trauma patients, this phenomenon also holds true. In 2015, Moore and colleagues discovered that patients admitted for traumatic injury who suffered from extreme social and/or material deprivation had longer acute care lengths of stay and a higher risk of unplanned rehospitalisation due to complications of the injury in the 30 days following discharge 39 40. These studies are compatible with our findings that SES can still affect the outcomes of trauma patients, even under a single-payer system with universal coverage.…”

Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury

“…The average hospital LOS in Aboriginal and Torres Strait Islander children hospitalised for asthma, chest or skin infections is 2-5 nights; for burn injuries it is 6 nights (Department of Social Services 2009; Department of Social Services 2011; Möller et al 2017). Long admissions can cause significant trauma, instigating episodes of posttraumatic stress in parents, which also impacts adversely on a child's recovery and health outcomes (McGarry et al 2015;Moore et al 2015). These are factors which can be exacerbated in Aboriginal and Torres Strait Islander families, who already face high levels of trauma, and who typically place less trust in the hospital system than their general practitioner (Department of Social Services 2012).…”

Residential area deprivation and risk of subsequent hospital admission in a British population: the EPIC-Norfolk cohort

“…Most studies examining deprivation in the context of health, disease and mortality either rely on area-based measures collected, for example, from census data16–20 or from individual level data from questionnaires 13 14. We had access to both forms of information, having derived individual social class and education level from self-reported questionnaires and area level measures from residential postcode linkage.…”

“…Increasing age and male sex and the modifiable factors current cigarette smoking, body mass index (BMI) >30 kg/m 2 , manual social class and low education level were all associated with higher future hospital usage over a 10-year period. Area-based deprivation measures, available routinely in the UK using postal code linkage, have also reported associations with hospital usage 16–20. However, the participants in such studies are often limited to those attending hospital and so a suitable population denominator is lacking.…”