How can socioeconomic inequalities in hospital admissions be explained? A cohort study

McCartney, Gerry; Hart, Carole; Watt, Graham

doi:10.1136/bmjopen-2012-002433

Cited by 21 publications

(23 citation statements)

References 33 publications

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“…Our results are consistent with those observed in other studies carried out in high-income countries [4,5,9,[20][21], where higher hospitalisation rates of more disadvantaged individuals are at least partially explained by more frequent and more serious diseases arising from exposure to unhealthy lifestyles and to settings that put health at greater risk, as well as to limited recourse to primary and to secondary care [22][23].…”

Section: Discussionsupporting

confidence: 92%

“…Numerous studies in developed countries have highlighted that hospital admissions are more frequent among people at a low socioeconomic level [4][5][6]; this has been observed in Italy as well [7]. These findings may be partially explained in terms of health needs: disadvantaged groups have more likely worse health status due to a higher prevalence of multiple chronic diseases [8].…”

Section: Introductionmentioning

confidence: 98%

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Socioeconomic and citizenship inequalities in hospitalisation of the adult population in Italy

Petrelli¹,

Napoli²,

Demuru³

et al. 2020

PLoS ONE

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Background Higher levels of hospital admissions among people with lower socioeconomic level, including immigrants, have been observed in developed countries. In Europe, immigrants present a more frequent use of emergency services compared to the native population. The aim of our study was to evaluate the socioeconomic and citizenship differences in the hospitalisation of the adult population in Italy. Methods The study was conducted using the database created by the record linkage between the National Health Interview Survey (2005) with the National Hospital Discharge Database (2005-2014). 79,341 individuals aged 18-64 years were included. The outcomes were acute hospital admissions, urgent admissions and length of stay (1-7 days, > = 8 days). Education level, occupational status, self-perceived economic resources and migratory status were considered as socioeconomic determinants. A multivariate proportional hazards model for recurrent events was used to estimate the risk of total hospital admissions. Logistic models were used to estimate the risk of urgent hospitalisation as well as of length of stay. Results Low education level, the lack of employment and negative self-perceived economic resources were conditions associated with the risk of hospitalisation, a longer hospital stay and greater recourse to urgent hospitalisation. Foreigners had a lower risk of hospitalisation (HR = 0.75; 95% CI:0.68-0.83) but a higher risk of urgent hospitalisation (OR = 1.36; 95% CI:1.18-1.55) and more frequent hospitalisations with a length of stay of at least eight days (OR = 1.19; 95% CI:1.02-1.40).

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 98%

Socioeconomic and citizenship inequalities in hospitalisation of the adult population in Italy

Petrelli¹,

Napoli²,

Demuru³

et al. 2020

PLoS ONE

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“…9 28 29 The association of deprivation with emergency admissions in general has been well documented but not well explained. 30 A previous study (not using patient-level data) showed that deprivation was independently associated with COPD admission. 18 Why deprivation remains a significant risk factor in our adjusted model for first AECOPD admission should be further explored.…”

Section: Discussionmentioning

confidence: 96%

Patient characteristics associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records

et al. 2016

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ObjectivesTo investigate patient characteristics of an unselected primary care population associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (AECOPD).DesignRetrospective open cohort using pseudonymised electronic primary care data linked to secondary care data.SettingPrimary care; Lothian (population approximately 800 000), Scotland.ParticipantsData from 7002 patients from 72 general practices with a COPD diagnosis date between 2000 and 2008 recorded in their primary care record. Patients were followed up until 2010, death or they left a participating practice.Main outcome measuresFirst and subsequent admissions for AECOPD (International Classification of Diseases (ICD) 10 codes J44.0, J44.1 in any diagnostic position) after COPD diagnosis in primary care.Results1756 (25%) patients had at least 1 AECOPD admission; 794 (11%) had at least 1 readmission and the risk of readmission increased with each admission. Older age at diagnosis, more severe COPD, low body mass index (BMI), current smoking, increasing deprivation, COPD admissions and interventions for COPD prior to diagnosis in primary care, and comorbidities were associated with higher risk of first AECOPD admission in an adjusted Cox proportional hazards regression model. More severe COPD and COPD admission prior to primary care diagnosis were associated with increased risk of AECOPD readmission in an adjusted Prentice-Williams-Peterson model. High BMI was associated with a lower risk of first AECOPD admission and readmission.ConclusionsSeveral patient characteristics were associated with first AECOPD admission in a primary care cohort of people with COPD but fewer were associated with readmission. Prompt diagnosis in primary care may reduce the risk of AECOPD admission and readmission. The study highlights the important role of primary care in preventing or delaying a first AECOPD admission.

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“…Furthermore, the risk of admission to hospital was exacerbated by the coexistence of mental health conditions and socioeconomic deprivation and was also higher in the youngest age groups compared with the middle-aged. It has also been shown that for those with mental health problems there is a marked social patterning for hospital admissions 45. Given the higher rates of combined physical and mental multimorbidity in the younger age groups, particularly in the most deprived areas, this suggests that focusing on these people could offer potential for a reduction in preventable admissions.…”

Section: Discussionmentioning

confidence: 99%

The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study

et al. 2014

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BackgroundMultimorbidity occurs at a younger age in individuals in areas of high socioeconomic deprivation but little is known about the ‘typology’ of multimorbidity in different age groups and its association with socioeconomic status.AimTo characterise multimorbidity type and most common conditions in a large nationally representative primary care dataset in terms of age and deprivation.Design and settingCross-sectional analysis of 1 272 685 adults in Scotland.MethodMultimorbidity type of participants (physical-only, mental-only, mixed physical, and mental) and most common conditions were analysed according to age and deprivation.ResultsMultimorbidity increased with age, ranging from 8.1% in those aged 25–34 to 76.1% for those aged ≥75 years. Physical-only (56% of all multimorbidity) was the most common type of multimorbidity in those aged ≥55 years, and did not vary substantially with deprivation. Mental-only was uncommon (4% of all multimorbidity), whereas mixed physical and mental (40% of all multimorbidity) was the most common type of multimorbidity in those aged <55 years and was two- to threefold more common in the most deprived compared with the least deprived in most age groups. Ten conditions (seven physical and three mental) accounted for the top five most common conditions in people with multimorbidity in all age groups. Depression and pain featured in the top five conditions across all age groups. Deprivation was associated with a higher prevalence of depression, drugs misuse, anxiety, dyspepsia, pain, coronary heart disease, and diabetes in multimorbid patients at different ages.ConclusionMixed physical and mental multimorbidity is common across the life-span and is exacerbated by deprivation from early adulthood onwards.

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How can socioeconomic inequalities in hospital admissions be explained? A cohort study

Cited by 21 publications

References 33 publications

Socioeconomic and citizenship inequalities in hospitalisation of the adult population in Italy

Socioeconomic and citizenship inequalities in hospitalisation of the adult population in Italy

Patient characteristics associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records

The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study

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