Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
Eur J Public Health. 2021 Jul 13;31(3):467-473. doi: 10.1093/eurpub/ckaa207.
Socioeconomic inequalities in health and healthcare use in old age have been on the rise during the past two decades. So far, it is unknown whether these inequalities have permeated the nursing home setting. This study aimed to assess whether the socioeconomic position of newly admitted nursing home residents had an influence on their risk of unplanned hospitalization.
We identified older persons (≥75 years) who were newly admitted to a nursing home between March 2013 and December 2014 using a set of linked routinely collected administrative and healthcare data in Sweden. The number of unplanned hospitalizations for any cause and the cumulative length of stay were defined as primary outcomes. Unplanned hospitalizations for potentially avoidable causes (i.e. fall-related injuries, urinary tract infections, pneumonia and decubitus ulcers) were considered as our secondary outcome.
Among 40 545 newly admitted nursing home residents (mean age 86.8 years), the incidence rate of unplanned hospitalization ranged from 53.9 per 100 person-years among residents with tertiary education up to 55.1 among those with primary education. After adjusting for relevant confounders, we observed no meaningful difference in the risk of unplanned hospitalization according to the education level of nursing home residents (IRR for tertiary vs. primary education: 0.96, 95% CI 0.92-1.00) or to their level of income (IRR for highest vs. lowest quartile of income: 0.98, 0.95-1.02). There were also no differences in the cumulative length of hospital stays or in the risk of experiencing unplanned hospitalizations for potentially avoidable causes.
In sum, in this large cohort of newly admitted nursing home residents, we found no evidence of socioeconomic inequalities in the risk of unplanned hospitalization.
在过去的二十年中，老年人的健康和医疗保健使用方面的社会经济不平等现象一直在加剧。到目前为止，尚不清楚这些不平等现象是否已经渗透到疗养院环境中。本研究旨在评估新入住疗养院的居民的社会经济地位是否会影响他们计划外住院的风险。
我们使用瑞典一组链接的常规收集的行政和医疗保健数据，确定了 2013 年 3 月至 2014 年 12 月期间新入住疗养院的老年人（≥75 岁）。任何原因的计划外住院次数和累计住院时间被定义为主要结局。将潜在可避免的原因（即与跌倒相关的伤害，尿路感染，肺炎和褥疮）引起的计划外住院视为次要结局。
在 40545 名新入住疗养院的居民（平均年龄 86.8 岁）中，计划外住院的发生率范围从接受高等教育的居民的 53.9/100 人年到接受小学教育的居民的 55.1/100 人年。在调整了相关混杂因素后，我们观察到，根据疗养院居民的教育程度（高等教育与小学教育的 IRR：0.96，95％CI 0.92-1.00）或收入水平（最高收入与最低收入四分位数的 IRR：0.98，0.95-1.02），计划外住院的风险没有明显差异。在累积住院时间或计划外住院治疗潜在可避免原因的风险方面也没有差异。
总之，在这项大型新入住疗养院居民队列研究中，我们没有发现计划外住院风险存在社会经济不平等的证据。
