Inequalities in avoidable hospitalisation in large urban areas: retrospective observational study in the metropolitan area of Milan

Abstract

ObjectiveSignificant inequalities in access to healthcare system exist between residents of world megacities, even if they have different healthcare systems. The aim of this study was to estimate avoidable hospitalisations in the metropolitan area of Milan (Italy) and explore inequalities in access to healthcare between patients and across their areas of residence.DesignRetrospective observational study.SettingPublic and accredited private hospitals in the metropolitan area of Milan. Data obtained from the hospital discharge database of the Italian Health Ministry.Participants472 579 patients hospitalised for ambulatory care sensitive conditions and resident in the metropolitan area of Milan from 2005 to 2016.Outcome measureAge-adjusted rates of avoidable hospitalisations; OR for hospital admissions with ambulatory care sensitive conditions.MethodsAge-adjusted rates of avoidable hospitalisations in the metropolitan area of Milan were estimated from 2005 to 2016 using direct standardisation. For the hospitalised population, multilevel logistic regression model with patient random effects was used to identify patients, hospitals and municipalities’ characteristics associated with risk of avoidable hospitalisation in the period 2012–2016.ResultsThe rate of avoidable hospitalisation in Milan fell steadily between 2005 and 2016 from 16.6 to 10.5 per 1000. Among the hospitalised population, the odds of being hospitalised with an ambulatory care sensitive condition was higher for male (OR 1.42, 95% CI 1.36 to 1.48), older (OR 1.012, 95% CI 1.01 to 1.014), low-educated (elementary school vs degree OR 4.23, 95% CI 3.72 to 4.81) and single (vs married OR 2.08, 95% CI 2.01 to 2.16) patients with comorbidities (OR 1.47, 95% CI 1.38 to 1.56); avoidable admissions were more frequent in public non-teaching hospitals while municipality’s characteristics did not appear to be correlated with hospitalisation for ambulatory care sensitive conditions.ConclusionsThe health system in metropolitan Milan has experienced a reduction in avoidable hospitalisations between 2005 and 2016, quite homogeneously across its 134 municipalities. The study design allowed to explore inequalities among the hospitalised population for which we found specific sociodemographic disadvantages.

Avoidable hospitalizations and access to primary care: comparisons among Italians, resident immigrants and undocumented immigrants in administrative hospital discharge records

“… 15 , 16 , 17 Regression results here for age, sex and educational level effects on total AH ( Table 2 ) echo results recently observed using the HDR to measure AH for the metropolitan area of Milan, a study that also found declining rates of hospitalizations and age-adjusted and overall rates of AH over time (2005-2016). 12 …”

“…AHs are hospitalizations due to ambulatory care sensitive conditions (ACSC), i.e., medical conditions for which hospitalization is not needed when primary care is timely and effective. 9 The incidence of AHs and ACSCs has been extensively used to proxy for quality of, and access to, preventive health services within and across countries 9 , 10 , 11 , 12 and to detect inequalities related to race and ethnicity, 13 , 14 socioeconomic conditions, 15 , 16 , 17 and immigrant status. 13 , 18 , 19 In the European context, evidence on immigrants’ AH rates is relatively recent 18 and in general shows that immigrants experience a higher risk of AHs, although results differ by country, reason to migrate and illness.…”

Preschool-located influenza vaccination and influenza-like illness surveillance: an Italian pilot experience

“…Lombardy is the most populated region in Italy, counting one-sixth of the Italian population, and according to the Italian National Institute of Statistics (22), it ranked first for the total number of non-Italian citizens. Milan, its administrative centre, has a population of approximately 1.4 million inhabitants, including over 200,000 foreigners, mainly in the suburbs (23). Children aged 2-6 years old are about 55,000, of which 27% do not have the Italian citizenship.…”

Expanding outpatient benefits package can reduce diabetes-related avoidable hospitalizations

“…Avoidable hospitalizations are those that can be avoided through timely, effective, and adequate primary health care services (6). If patients have access to timely and effective ambulatory care, it is possible to reduce hospitalizations for these conditions by preventing the occurrence of diseases or managing chronic conditions in an outpatient setting (7). Diabetes mellitus has now been included in many index systems of avoidable hospitalizations diseases across the world (8)(9)(10)(11).…”