Urban deprivation and public hospital admissions in Christchurch, New Zealand, 1990-1997

Abstract

The present paper examines the relationship between deprivation and changing patterns of public hospital admissions in Christchurch, New Zealand, between 1992 and 1997, during a time of economic restructuring and rapid change in the health sector. The total set of admissions into Christchurch Hospital was geocoded according to the meshblock domicile of each patient. Domiciles were classified into 10 decile categories using the NZDep91 and NZDep96 measures of deprivation. Regression analysis was used to measure changes in the relationship between deprivation and different types of admissions. Differences between admission rates for people living in the most and least deprived areas increased over time, especially following the implementation of the 1993 health reforms. This was most marked for younger adults (ages = 25-44 years), day patients, and especially, acute day patients, ambulatory-care-sensitive admissions and re-admissions. The average length of stay also varied by deprivation and appeared to be an important cause of the increasingly high rate of re-admissions. On average, patients from more affluent areas are hospitalised longer than low-income patients, although the differences narrow over time. The results suggest that the widening social gap in hospitalisation rates is a result of the effects of poverty and problems of access to primary care. However, more research on different admission pathways and causes of admissions for different patients from different parts of the city is needed to confirm these observations.

Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs?

“…Evaluation of socioeconomic factors in determining admission and therapeutic choices for patients accessing E.D. has been already carried out for many diseases, demonstrating a direct correlation [17,18]. Same findings were reported for bronchiolitis.…”

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

“…Social patterning in hospital admissions has been found internationally4–7 and in England and Scotland 27–31. Adjusting for the deprivation profile and demographic characteristics of practice populations leaves a large amount of variation in hospital admissions unexplained 29…”

“…Higher hospital admission rates have been associated with lower socioeconomic status in Amsterdam (for psychiatric admissions),3 New Zealand (for general and psychiatric admissions),4 and for Australia,5 Norway6 and London7 (for general hospital admissions), although the patterning is less clear in Italy,8–10 Canada11 12 and the USA 13 14. Where longitudinal data are available, antecedent morbidity or risk factors can explain part of this patterning (as lower socioeconomic status is associated with greater healthcare needs) 9 13 14.…”

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Geographical inequalities in health in New Zealand, 1980–2001: the gap widens

“…42,43 This was a signifi cant trend especially since poor access to primary health care services is the health system factor most likely to be related to poor health outcomes 44 and increased rates of hospitalisation of the poor. 45 Moreover, continued rationing of public hospital services has affected some regions more than others 46 and may well have contributed to emerging disparities in health outcomes. As the health needs in particular areas rise it becomes more and more diffi cult to provide a similar standard of care in those areas as in other areas as the time of general practitioners and other health professionals is increasingly spent on immediate treatment, leaving less time available for preventive work.…”