Institute for Social Work and Health, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland.
PLoS One. 2022 Aug 24;17(8):e0272265. doi: 10.1371/journal.pone.0272265. eCollection 2022.
Social factors are recognized determinants of morbidity and mortality and also have an impact on use of medical services. The objective of this study was to assess the associations of educational attainment, social and financial resources, and migration factors with length of hospital stays for chronic conditions. In addition, the study investigated the role of comorbidity and discharge destination in mediating these associations. The study made use of nationwide inpatient data that was linked with Swiss census data. The study sample included n = 141,307 records of n = 92,623 inpatients aged 25 to 84 years, hospitalized between 2010 and 2016 for a chronic condition. Cross-classified multilevel models and mediation analysis were performed. Patients with upper secondary and compulsory education stayed longer in hospital compared to those with tertiary education (β 0.24 days, 95% CI 0.14-0.33; β 0.37, 95% CI 0.27-0.47, respectively) when taking into account demographic factors, main diagnosis and clustering on patient and hospital level. However, these effects were almost fully mediated by burden of comorbidity. The effect of living alone on length of stay (β 0.60 days, 95% CI 0.50-0.70) was partially mediated by both burden of comorbidities (33%) and discharge destination (30.4%). (Semi-) private insurance was associated with prolonged stays, but an inverse effect was observed for colon and breast cancer. Allophone patients had also prolonged hospital stays (β 0.34, 95% CI 0.13-0.55). Hospital stays could be a window of opportunity to discern patients who need additional time and support to better cope with everyday life after discharge, reducing the risks of future hospital stays. However, inpatient care in Switzerland seems to take into account rather obvious individual needs due to lack of immediate support at home, but not necessarily more hidden needs of patients with low health literacy and less resources to assert their interests within the health system.
社会因素被认为是发病率和死亡率的决定因素,也会对医疗服务的利用产生影响。本研究旨在评估教育程度、社会和经济资源以及移民因素与慢性病住院时间的关系。此外,该研究还调查了合并症和出院去向在调节这些关联中的作用。该研究利用了全国性的住院数据,并将其与瑞士人口普查数据进行了关联。研究样本包括 n = 141,307 名记录,n = 92,623 名 25 至 84 岁的住院患者,他们在 2010 年至 2016 年期间因慢性病住院。采用交叉分类多水平模型和中介分析。与接受高等教育的患者相比,接受中等教育和义务教育的患者住院时间更长(考虑到人口统计学因素、主要诊断和患者和医院层面的聚类时,β 0.24 天,95%CI 0.14-0.33;β 0.37,95%CI 0.27-0.47)。然而,这些影响几乎完全由合并症负担所介导。独居对住院时间的影响(β 0.60 天,95%CI 0.50-0.70)部分由合并症负担(33%)和出院去向(30.4%)介导。(半)私人保险与住院时间延长有关,但结肠癌和乳腺癌则相反。非母语患者的住院时间也较长(β 0.34,95%CI 0.13-0.55)。住院时间可能是一个机会窗口,可以发现那些需要额外时间和支持以更好地应对出院后日常生活的患者,从而降低未来住院的风险。然而,瑞士的住院治疗似乎考虑到了由于缺乏家庭即时支持而导致的明显的个人需求,但不一定考虑到健康素养较低的患者和在卫生系统中维护自身利益的资源较少的患者的更隐蔽的需求。