Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden.
Health Technology Assessment Skåne, Skåne University Hospital, Lund, Sweden.
Eur J Health Econ. 2018 Apr;19(3):447-462. doi: 10.1007/s10198-017-0895-5. Epub 2017 May 19.
We used a southern Swedish cohort of psoriasis (PSO) and psoriatic arthritis (PsA) patients and population-based referents (N = 57,800) to investigate the influence of socioeconomic and demographic factors on the probability of healthcare use and on healthcare costs when controlling for need as measured by PSO/PsA and common additional morbidities such as diabetes, depression and myocardial infarction. People with PSO/PsA were identified by ICD-10 codes in the Skåne Healthcare Register 1998-2007. Resource use and costs for years 2008-2011 were retrieved from the Skåne Healthcare Register and the Swedish Prescribed Drug Register, and socioeconomic data were retrieved from Statistics Sweden. After controlling for PSO/PsA and common additional morbidities, income, and to some extent education, had significant effects on the probability of five types of healthcare use. Overall, income showed a bell-shaped relationship to healthcare costs, with patients in income quintiles 2 and 3 having the highest mean annualized cost irrespective of model specification. Education did not have a significant effect in most specifications. Analyses including interaction effects indicated similarly higher costs across income quintiles in the PSO and PsA subgroups, though these cost differences were lower in magnitude for patients with PSO in quintile 5 and with PsA in quintile 1. In conclusion, our results show persistent socioeconomic disparities in healthcare use among a cohort of chronically ill patients and referents, even after controlling for the presence of PSO/PsA and common additional morbidities. These disparities persist even in a country with general healthcare coverage and low out-of-pocket payments.
我们利用瑞典南部的银屑病（PSO）和银屑病关节炎（PsA）患者队列以及基于人群的对照者（N=57800），调查了社会经济和人口因素对医疗保健使用概率的影响，以及在控制 PSO/PsA 以及常见合并症（如糖尿病、抑郁症和心肌梗死）所测量的需求后，对医疗保健成本的影响。PSO/PsA 患者通过 1998-2007 年斯科讷医疗保健登记处的 ICD-10 代码确定。2008-2011 年的资源使用和成本从斯科讷医疗保健登记处和瑞典处方药物登记处获取，社会经济数据从瑞典统计局获取。在控制 PSO/PsA 和常见合并症后，收入，在一定程度上还有教育，对五种类型的医疗保健使用概率有显著影响。总体而言，收入与医疗保健成本呈钟形关系，无论模型规格如何，收入五分位数 2 和 3 的患者的平均年化成本最高。在大多数规格中，教育没有显著影响。包括交互效应的分析表明，PSO 和 PsA 亚组的收入五分位数内的患者存在类似的更高成本，但对于五分位数 5 的 PSO 患者和五分位数 1 的 PsA 患者，这些成本差异的幅度较低。总之，我们的结果表明，在一组慢性病患者和对照者中，即使在控制了 PSO/PsA 和常见合并症的情况下，医疗保健使用方面仍存在持续的社会经济差异。这些差异在一个拥有普遍医疗保健覆盖和低自付费用的国家仍然存在。
