Socioeconomic differences in inpatient care expenditure in the last year of life among older people: a retrospective population-based study in Stockholm County
Objectives To investigate the association between inpatient care expenditure (ICE) and income group and the effect of demographic factors, health status, healthcare and social care utilisation on ICE in the last year of life.Design Retrospective population-based study.Setting Stockholm County.Partic...
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e060981.full |
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| author | Bo Burström Nicola Orsini Megan Doheny Pär Schön Anders Walander J Agerholm |
| author_facet | Bo Burström Nicola Orsini Megan Doheny Pär Schön Anders Walander J Agerholm |
| author_sort | Bo Burström |
| collection | DOAJ |
| description | Objectives To investigate the association between inpatient care expenditure (ICE) and income group and the effect of demographic factors, health status, healthcare and social care utilisation on ICE in the last year of life.Design Retrospective population-based study.Setting Stockholm County.Participants Decedents ≥65 years in 2015 (N=13 538).Outcome ICE was calculated individually for the month of, and 12 months preceding death using healthcare register data from 2014 and 2015. ICE included the costs of admission and treatment in inpatient care adjusted for the price level in 2018.Results There were difference between income groups and ICE incurred at the 75th percentile, while a social gradient was found at the 95th percentile where the highest income group incurred higher ICE (SEK45 307, 95% CI SEK12 055 to SEK79 559) compared with the lowest income groups. Incurring higher ICE at the 95th percentile was driven by greater morbidity (SEK20 333, 95% CI SEK12 673 to SEK29 993) and emergency department care visits (SEK77 995, 95% CI SEK64 442 to SEK79 549), while lower ICE across the distribution was associated with older age and residing in institutional care.Conclusion Gaining insight into patterns of healthcare expenditure in the last year of life has important implications for policy, particularly as socioeconomic differences were visible in ICE at a time of greater care need for all. Future policies should focus on engaging in advanced care planning and strengthening the coordination of care for older people. |
| format | Article |
| id | doaj-art-f41fce6db2814d28b15192dd1417677a |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-f41fce6db2814d28b15192dd1417677a2025-01-31T06:45:09ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2022-060981Socioeconomic differences in inpatient care expenditure in the last year of life among older people: a retrospective population-based study in Stockholm CountyBo Burström0Nicola Orsini1Megan Doheny2Pär Schön3Anders Walander4J Agerholm54 Department of Public Health Sciences, Karolinska Institutet, Stockholm, SwedenGlobal Public Health, Karolinska Institutet, Stockholm, SwedenGlobal Public Health, Karolinska Institutet, Stockholm, SwedenAging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, SwedenCenter for Epidemiology and Community Medicine, Region Stockholm, Stockholm, SwedenAging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, SwedenObjectives To investigate the association between inpatient care expenditure (ICE) and income group and the effect of demographic factors, health status, healthcare and social care utilisation on ICE in the last year of life.Design Retrospective population-based study.Setting Stockholm County.Participants Decedents ≥65 years in 2015 (N=13 538).Outcome ICE was calculated individually for the month of, and 12 months preceding death using healthcare register data from 2014 and 2015. ICE included the costs of admission and treatment in inpatient care adjusted for the price level in 2018.Results There were difference between income groups and ICE incurred at the 75th percentile, while a social gradient was found at the 95th percentile where the highest income group incurred higher ICE (SEK45 307, 95% CI SEK12 055 to SEK79 559) compared with the lowest income groups. Incurring higher ICE at the 95th percentile was driven by greater morbidity (SEK20 333, 95% CI SEK12 673 to SEK29 993) and emergency department care visits (SEK77 995, 95% CI SEK64 442 to SEK79 549), while lower ICE across the distribution was associated with older age and residing in institutional care.Conclusion Gaining insight into patterns of healthcare expenditure in the last year of life has important implications for policy, particularly as socioeconomic differences were visible in ICE at a time of greater care need for all. Future policies should focus on engaging in advanced care planning and strengthening the coordination of care for older people.https://bmjopen.bmj.com/content/12/7/e060981.full |
| spellingShingle | Bo Burström Nicola Orsini Megan Doheny Pär Schön Anders Walander J Agerholm Socioeconomic differences in inpatient care expenditure in the last year of life among older people: a retrospective population-based study in Stockholm County BMJ Open |
| title | Socioeconomic differences in inpatient care expenditure in the last year of life among older people: a retrospective population-based study in Stockholm County |
| title_full | Socioeconomic differences in inpatient care expenditure in the last year of life among older people: a retrospective population-based study in Stockholm County |
| title_fullStr | Socioeconomic differences in inpatient care expenditure in the last year of life among older people: a retrospective population-based study in Stockholm County |
| title_full_unstemmed | Socioeconomic differences in inpatient care expenditure in the last year of life among older people: a retrospective population-based study in Stockholm County |
| title_short | Socioeconomic differences in inpatient care expenditure in the last year of life among older people: a retrospective population-based study in Stockholm County |
| title_sort | socioeconomic differences in inpatient care expenditure in the last year of life among older people a retrospective population based study in stockholm county |
| url | https://bmjopen.bmj.com/content/12/7/e060981.full |
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