Inequalities in avoidable hospitalisation by area income and the role of individual characteristics: a population-based register study in Stockholm County, Sweden

Abstract

Higher rates of avoidable hospitalisation in low-income areas indicate greater healthcare needs of people living there. This should be addressed by investing in outpatient care for lower socioeconomic groups. The composition of individuals must be considered when studying area characteristics and avoidable hospitalisation.

Socioeconomic inequalities in hospitalizations for chronic ambulatory care sensitive conditions: a systematic review of peer-reviewed literature, 1990–2018

“…SES is one of the most studied risk factors for ACSC hospitalizations. First described by Billings et al in New York City [8], multiple studies have independently observed an association between SES and ACSC hospitalizations [12][13][14][15][16]. However, to our knowledge, these studies have not been systematically described.…”

No man is an island: disentangling multilevel effects in health services research

“…In many cases what is selected is not what is ideal, but rather what is available. For example, Lofqvist et al 3 use the municipality or city district median income as a measure of area-level socioeconomic status but, as they describe, these areas vary in size from 10 000 to 900 000 residents. This broad range of variation would bias estimates towards observing no contextual effect.…”

“…In their analyses, Lofqvist et al 3 performed logistic regression models that included both individual- and area-level factors as covariates. Their approach improved over studies that only used individual or contextual measures, but their analytical method limited the extent to which inferences may be drawn about what constitutes a ‘contextual’ effect.…”

“…In this issue of the journal, Lofqvist et al 3 try to disentangle the potential explanations for the worse outcomes experienced by financially disadvantaged patients. The specific aspect of healthcare they explore is avoidable hospitalisations.…”

“…For common chronic illnesses such as asthma, chronic obstructive pulmonary disease, diabetes, hypertension and heart failure, effective ambulatory care should reduce the frequency of hospitalisation 4. Using income and hospitalisation data from 43 city districts and municipalities in Stockholm, Sweden, Lofqvist et al 3 found that residence in the lowest income areas was associated with 29% higher odds of avoidable hospitalisation for these and other ambulatory care sensitive conditions. They then examined the extent to which this finding is explained by individual-level versus area-level characteristics.…”