Effect of socioeconomic disadvantage, remoteness and Indigenous status on hospital usage for Western Australian preterm infants under 12 months of age: a population-based data linkage study

Strobel, Natalie; Peter, Sue; McAuley, Kimberley; McAullay, Daniel; Marriott, Rhonda; Edmond, Karen

doi:10.1136/bmjopen-2016-013492

Cited by 6 publications

(5 citation statements)

References 28 publications

(24 reference statements)

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“…Children whose parents were working part‐time only, or with at least one parent unemployed, had about 30% increased risk of rehospitalisation and almost 40% higher healthcare costs; an even stronger association was found for low maternal education. These findings are in agreement with previous studies, reporting higher hospitalisation risk, more ED visits and increased length of hospital stay and costs in relation with lower social class.…”

Section: Discussionsupporting

confidence: 93%

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Low socio‐economic conditions and prematurity‐related morbidities explain healthcare use and costs for 2‐year‐old very preterm children

et al. 2020

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Aim To estimate healthcare use and related costs for 2‐year‐old very preterm (VP) children after discharge from the neonatal unit. Methods As part of a European project, we recruited an area‐based cohort including all VP infants born in three Italian regions (Lazio, Emilia‐Romagna and Marche) in 2011‐2012. At 2 years corrected age, parents completed a questionnaire on their child health and healthcare use (N = 732, response rate 75.6%). Cost values were assigned based on national reimbursement tariffs. We used multivariable analyses to identify factors associated with any rehospitalisation and overall healthcare costs. Results The most frequently consulted physicians were the paediatrician (85% of children), the ophthalmologist (36%) and the neurologist/neuropsychiatrist (26%); 38% of children were hospitalised at least once after the initial discharge, for a total of 513 admissions and over one million euros cost, corresponding to 75% of total healthcare costs. Low maternal education and parental occupation index, congenital anomalies and postnatal prematurity‐related morbidities significantly increased the risk of rehospitalisation and total healthcare costs. Conclusion Rehospitalisation and outpatient care are frequent in VP children, confirming a substantial health and economic burden. These findings should inform the allocation of resources to preventive and rehabilitation services for these children.

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Section: Discussionsupporting

confidence: 93%

“…Male sex has been consistently linked to several adverse health outcomes in preterm and term‐born children, including increased risk of hospitalisation, but the underlying mechanisms are still poorly understood.…”

Section: Discussionmentioning

confidence: 99%

Low socio‐economic conditions and prematurity‐related morbidities explain healthcare use and costs for 2‐year‐old very preterm children

et al. 2020

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“…Regarding inequalities in hospital admission, children living in urban settings are at high risk of hospitalization compared with those who live in rural areas. 5 Also, socially deprived ethnic groups 1 , 6 , 7 are at greater risk of hospital admission, the same occurring with emergency hospital admissions. 8 …”

Section: Introductionmentioning

confidence: 99%

Hospital admissions in the first year of life: inequalities over three decades in a southern Brazilian city

Wehrmeister

Victora

Horta

et al. 2019

International Journal of Epidemiology

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Background Hospital admissions in infancy are declining in several countries. We describe admissions to neonatal intensive care units (NICU) and other hospitalizations over a 33-year period in the Brazilian city of Pelotas. Methods We analysed data from four population-based birth cohorts launched in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. NICU and other hospital admissions during infancy were reported by the mothers in the perinatal interview and at the 12-month visit, respectively. We describe these outcomes by sex of the child, family income and maternal skin colour. Results In 1982, NICUs did not exist in the city; admissions into NICUs increased from 2.7% of all newborns in 1993 to 6.7% in 2015, and admission rates were similar in all income groups. Hospitalizations during the first year of life fell by 29%, from 23.7% in 1982 to 16.8% in 2015, and diarrhoea admissions fell by 95.2%. Pneumonia admissions fell by 46.3% from 1993 to 2015 (no data available for 1982). Admissions due to perinatal causes increased during the period. In the poorest income quintile, total admissions fell by 33% (from 35.7% to 23.9%), but in the richest quintile these remained stable at around 10%, leading to a reduction in inequalities. Over the whole period, children born to women with black or brown skin were 30% more likely to be admitted than those of white-skinned mothers. Conclusions Whereas NICU admissions increased, total admissions in the first year of life declined by nearly one-third. Socioeconomic disparities were reduced, but important gaps remain.

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“…We also use the Accessibility Remoteness Index of Australia (ARIA) as the remoteness indicator, as ARIA is strongly related to healthcare service utilisation in Australia. 20 The ABS has classified all Australian geographic regions into one of five categories: major cities, inner regional, outer regional, remote, and very remote. We use the postal area concordance file from the ABS to assign individuals to their respective IRSAD deciles, ARIA category, and state/territory.…”

Section: Independent Variablesmentioning

confidence: 99%

The link between out-of-pocket costs and inequality in specialist care in Australia

2022

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Objective Out-of-pocket (OOP) costs could act as a potential barrier to accessing specialist services, particularly among low-income patients. The aim of this study is to examine the link between OOP costs and socioeconomic inequality in specialist services in Australia. Methods This study is based on population-level data from the Medicare Benefits Schedule of Australia in 2014–15. Three outcomes of specialist care were used: all visits, visits without OOP costs (bulk-billed services), and visits with OOP costs. Logistic and zero-inflated negative binomial regression models were used to examine the association between outcome variables and area-level socioeconomic status after controlling for age, sex, state of residence, and geographic remoteness. The concentration index was used to quantify the extent of inequality. Results Our results indicate that the distribution of specialist visits favoured the people living in wealthier areas of Australia. There was a pro-rich inequality in specialist visits associated with OOP costs. However, the distribution of the visits incurring zero OOP cost was slightly favourable to the people living in lower socioeconomic areas. The pro-poor distribution of visits with zero OOP cost was insufficient to offset the pro-rich distribution among the visits with OOP costs. Conclusions OOP costs for specialist care might partly undermine the equity principle of Medicare in Australia. This presents a challenge to the government on how best to influence the rate and distribution of specialists’ services.

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Effect of socioeconomic disadvantage, remoteness and Indigenous status on hospital usage for Western Australian preterm infants under 12 months of age: a population-based data linkage study

Cited by 6 publications

References 28 publications

Low socio‐economic conditions and prematurity‐related morbidities explain healthcare use and costs for 2‐year‐old very preterm children

Low socio‐economic conditions and prematurity‐related morbidities explain healthcare use and costs for 2‐year‐old very preterm children

Hospital admissions in the first year of life: inequalities over three decades in a southern Brazilian city

The link between out-of-pocket costs and inequality in specialist care in Australia

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