Hospital Deaths in Sweden: Are Individual Socioeconomic Factors Relevant?

Abstract

As the proportion of deaths in hospital falls, it is important to ensure that social disadvantage has no role in determining place of death. This study investigated the association between individual sociodemographic factors and deaths in hospitals for the population of Stockholm County, Sweden, using linked population registers. In 2002, 14,517 (87%) of the 16,617 adult decedents in Stockholm County had contact with health services in the three years before they died. Twenty-two percent (3,210) of these deaths were in hospitals. Individual income, education, country of birth, and gender had no influence on likelihood of hospital death in multivariate analyses. Decedent characteristics associated with higher chance of hospital death included older age, being married, diagnosis of heart disease, and contact with ambulatory services (not family practitioners) in the three years before death. Cancer patients were no more or less likely than those without cancer to die in hospital. In health systems wishing to reduce an already low proportion of deaths in acute hospitals, enhancing palliative and social support for older patients and people with noncancer diagnoses may merit attention.

Predictors of Home Care Expenditures and Death at Home for Cancer Patients in an Integrated Comprehensive Palliative Home Care Pilot Program

“…This finding is consistent with studies in other publicly funded healthcare programs (Cartwright 1992;goddard and smith 2001;Hanratty et al 2007). Increased purchasing power for those in higher social positions has been linked to a demand for services (Coyte and Howell 2000).…”

Socioeconomic position and place of death of cancer patients

“…Hanratty et al did not find any association between income and dying in hospital 29. We adjusted for other coherent variables to income, such as housing space and urbanicity, but still, income made a difference to the place of death.…”

Trends in Hospital Deaths in Denmark from 1980 to 2014, at Ages 50 and Older

“…In Sweden, individuals with a higher education are more likely to live in the community until the end of their lives, and they are more likely to be transferred to the hospital shortly before death than those with a primary education . Although another Swedish study found no association between hospital deaths and SES, the study population was limited to persons in Stockholm County who had at least one contact with the health system in the previous 3 years …”

“…38 Although another Swedish study found no association between hospital deaths and SES, the study population was limited to persons in Stockholm County who had at least one contact with the health system in the previous 3 years. 32 It is likely that the income measure partially captures the effect of education. People with higher education are more likely to live in cities or nearby where hospitals are available, and thus they can more easily be transferred to a hospital than their lower educated counterparts.…”