Ahmed Moin, Maguire Sarah, Dann Kelly M, Scheneuer Francisco, Kim Marcellinus, Miskovic-Wheatley Jane, Maloney Danielle, Nassar Natasha, Cunich Michelle
MAINSTREAM The Australian National Centre for Health System Research and Translation, Sydney, NSW, Australia.
Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Sydney NSW 2006, Australia.
Psychol Med. 2024 Oct 4;54(14):1-13. doi: 10.1017/S0033291724002290.
Little is known about socioeconomic equity in access to healthcare among people with eating disorders in Australia. This study aims to measure the extent of inequity in eating disorder-related healthcare utilization, analyze trends, and explore the sources of inequalities using New South Wales (NSW) administrative linked health data for 2005 to 2020.
Socioeconomic inequities were measured using concentration index approach, and decomposition analysis was conducted to explain the factors accounting for inequality. Healthcare utilization included: public inpatient admissions, private inpatient admissions, visits to public mental health outpatient clinics and emergency department visits, with three different measures (probability of visit, total and conditional number of visits) for each outcome.
Private hospital admissions due to eating disorders were concentrated among individuals from higher socioeconomic status (SES) from 2005 to 2020. There was no significant inequity in the probability of public hospital admissions for the same period. Public outpatient visits were utilized more by people from lower SES from 2008 to 2020. Emergency department visits were equitable, but more utilized by those from lower SES in 2020.
Public hospital and emergency department services were equitably used by people with eating disorders in NSW, but individuals from high SES were more likely to be admitted to private hospitals for eating disorder care. Use of public hospital outpatient services was higher for those from lower SES. These findings can assist policymakers in understanding the equity of the healthcare system and developing programs to improve fairness in eating disorder-related healthcare in NSW.
在澳大利亚，关于饮食失调患者获得医疗保健的社会经济公平性，人们了解甚少。本研究旨在利用新南威尔士州（NSW）2005年至2020年的行政关联健康数据，衡量饮食失调相关医疗保健利用方面的不公平程度，分析趋势，并探索不平等的根源。
采用集中指数法衡量社会经济不平等，并进行分解分析以解释造成不平等的因素。医疗保健利用包括：公立医院住院、私立医院住院、公立精神科门诊就诊和急诊就诊，每个结果有三种不同的衡量指标（就诊概率、就诊总数和条件就诊数）。
2005年至2020年期间，因饮食失调导致的私立医院住院集中在社会经济地位较高的人群中。同期公立医院住院概率没有显著的不公平现象。2008年至2020年期间，社会经济地位较低的人群更多地利用了公立门诊服务。急诊就诊情况是公平的，但2020年社会经济地位较低的人群就诊更多。
新南威尔士州饮食失调患者公平地使用了公立医院和急诊服务，但社会经济地位高的人更有可能因饮食失调护理而入住私立医院。社会经济地位较低的人群对公立医院门诊服务的利用率更高。这些发现有助于政策制定者了解医疗保健系统的公平性，并制定计划以提高新南威尔士州饮食失调相关医疗保健的公平性。
