Abstract
This study quantifies the extent socioeconomic status (SES) affects hospital utilization and adverse hospital events of chronic disease patients. After identifying the initial first-year spell of the disease, we examine six outcomes that include measures of utilization and incidence of adverse in-hospital events. Three years of hospital administrative data from the state of Victoria, Australia, are used to extract a sample of 237,743 patients with chronic disease spells. SES is measured using the utilization records of specific health and human services. The study finds that, compared to patients with no disadvantage, SES disadvantaged patients tend to incur higher hospital costs and longer utilization by about 20% and greater incidence of in-hospital adverse outcomes by up to 80% than non-disadvantaged patients. Further analysis shows that hospital adverse outcomes indirectly contribute to about a quarter of the observed difference in hospital costs between SES disadvantaged and non-disadvantaged patients.
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Notes
Besides SES Group, other covariates include disease group dummies, gender, age, marital status, rurality, number of diagnoses, number of the previous admission, and ICU hours as a private patient. See “Appendix 1” for a complete listing of all covariates and their coefficient estimates.
The list of covariates in these regressions can be found in “Appendix 1”.
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Acknowledgements
This paper arises out of a project commissioned by the Victorian Department of Health and Human Services (DHHS). The views expressed herein are those of the authors and do not necessarily reflect the views of the Department. The authors are grateful to the Victorian DHHS for funding support and making possible access to the data, to Peter Breadon, Laura Andrew, Ross Geddes for many rounds of discussions on earlier drafts, and especially to Tristan Bouckley for coordinating the project and facilitating data access. The authors have no other competing interests to declare.
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Appendix 1: Additional tables
Appendix 1: Additional tables
Exclusion criteria
The following exclusion criteria are applied because patients with certain characteristics are considered to be different in important ways from other patients. For example, chronic disease patients suffering from complications such as cancer, HIV or an organ transplant are clearly in worse health and/or likely to incur much higher costs than patients who did not have such complications. Likewise, patients who died have an incomplete or truncated spell—had they survived, they might have recorded higher utilization and more adverse outcomes (Table 5).
Summary statistics of covariates used in regressions
Table 6 presents the summary statistics of the covariates by SES group. Generally patients in moderate and high disadvantage groups are older, more of them are widowed or divorced, living in major cities (where social services are more widely availabe than in regional and remote areas), and with more complex health conditions.
Regressions for estimating indirect effects in mediation analysis
Tables 7 and 8 show the coefficient estimates and standard errors for regression models estimated to conduct the mediation analysis to obtain the indirect effect estimates of SES. The indirect effect estimates reported in Table 4 are obtained as the product of the coefficients on adverse outcomes in Table 7 and the coefficients on SES in Table 8.
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Yong, J., Yang, O. Does socioeconomic status affect hospital utilization and health outcomes of chronic disease patients?. Eur J Health Econ 22, 329–339 (2021). https://doi.org/10.1007/s10198-020-01255-z
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DOI: https://doi.org/10.1007/s10198-020-01255-z