Walker Agnes, Pearse Jim, Thurecht Linc, Harding Ann
Australian Centre for Economic Research on Health, Australian National University, Australian Capital Territory.
Aust N Z J Public Health. 2006 Oct;30(5):467-73. doi: 10.1111/j.1467-842x.2006.tb00466.x.
To investigate whether the 'inverse care law' applies to New South Wales (NSW) hospital admissions--especially to older people with high socio-economic status (SES).
Cross-sectional study analysing inequalities in public and private hospital admission rates by SES, defined in terms of age, sex and family income/size at the small geographic area level.
Admissions to NSW public and private hospitals in 1999-2000 (1.8 million admissions against a NSW population of 6.4 million).
Inequalities in hospitalisation rates were expressed as rate ratios across the most and least disadvantaged 20% of the NSW population.
Public hospital admission rates for people aged 0-60 years were 24-35% higher for the most disadvantaged 20% of the NSW population than for the least disadvantaged 20%. For 70+ year-olds the direction of this difference was reversed--being 14% lower for the most disadvantaged 20% of the population (5% higher for public patients). For private hospitals this reversal prevailed for all age groups (23-49% lower). For all hospitals it was 16% and 27% lower for 60-69 and 70+ year-olds respectively, with higher admission rates for top SES 60+ year-olds most pronounced for renal dialysis, chemotherapy, colonoscopies and other diagnostic scopes, rehabilitation and follow-up, and cataract operations.
While the 'inverse care law' did apply to 60+ year-olds, it did not apply either to younger NSW hospital users or to public patients in public hospitals.
Awareness of these SES-level differentials should result in greater equality of access to hospital services, especially by older people.
调查“逆关怀法则”是否适用于新南威尔士州（NSW）的医院住院情况，尤其是适用于社会经济地位（SES）较高的老年人。
横断面研究，在小地理区域层面，根据年龄、性别和家庭收入/规模定义SES，分析公立和私立医院住院率的不平等情况。
1999 - 2000年新南威尔士州公立和私立医院的住院情况（新南威尔士州人口640万，住院人数180万）。
住院率的不平等情况以新南威尔士州最弱势和最不弱势的20%人群的率比来表示。
新南威尔士州最弱势的20%人群中，0 - 60岁人群的公立医院住院率比最不弱势的20%人群高24% - 35%。对于70岁及以上人群，这种差异的方向相反——最弱势的20%人群低14%（公立患者高5%）。对于私立医院，这种逆转在所有年龄组都存在（低23% - 49%）。对于所有医院，60 - 69岁和70岁及以上人群分别低16%和27%，SES最高的60岁及以上人群住院率较高，在肾透析、化疗、结肠镜检查及其他诊断检查、康复和随访以及白内障手术方面最为明显。
虽然“逆关怀法则”适用于60岁及以上人群，但不适用于新南威尔士州较年轻的医院使用者或公立医院的公立患者。
认识到这些SES水平差异应能使人们更平等地获得医院服务，尤其是老年人。
