Meulman Iris, Jansen Tessa, Uiters Ellen, Cloin Mariëlle, Polder Johan, Stadhouders Niek
Center for Public Health, Health Services and Society, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands.
Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
Int J Equity Health. 2025 May 28;24(1):154. doi: 10.1186/s12939-025-02518-y.
Lower socioeconomic status is associated with lower self-rated health and higher healthcare expenditure. This study identifies which chronic conditions and social determinants contribute most to socioeconomic differences in self-rated health and healthcare expenditure.
Registry and survey data combining 3 socioeconomic indicators (income, education, and financial welfare), 26 social determinants, 20 chronic conditions, age, sex, self-rated health, and healthcare expenditure for 135,183 Dutch individuals aged 25-65, were linked at individual level. Oaxaca-Blinder decomposition analyses were conducted to quantify the relative contributions of chronic conditions and social determinants to socioeconomic differences in self-rated health and healthcare expenditure.
Poorer self-rated health and higher healthcare expenditure among lower income groups were partly attributable to a higher prevalence of chronic conditions (33% and 70%, respectively). Acid-related disorders, cardiovascular diseases and psychological disorders contributed most to both differences in self-rated health and healthcare expenditure. Social determinants almost completely accounted for income differences in self-rated health. Social determinants explained more than the observed difference in healthcare expenditure between income groups, suggesting that, when adjusted for social determinants, lower income groups would have lower healthcare expenditure than higher income groups. Including both chronic conditions and social determinants in a single decomposition indicated that income security & social protection (28%), social & human capital (26%), and chronic conditions (23%) were equally important to income differences in self-rated health. For healthcare expenditure, chronic conditions and social determinants each accounted for approximately half of the socioeconomic differences.
Social determinants outside the healthcare sector accounted for almost all of the socioeconomic differences in self-rated health. This highlights the need for integrated policies across multiple domains, such as the social, economic and healthcare sector, to reduce avoidable health inequalities. Given that socioeconomic differences in healthcare expenditure were primarily associated with chronic conditions, prioritizing prevention of chronic conditions among lower socioeconomic groups can potentially reduce healthcare spending within this group and improve the healthcare system's sustainability and affordability.
较低的社会经济地位与较低的自评健康水平及较高的医疗保健支出相关。本研究确定了哪些慢性病和社会决定因素对自评健康和医疗保健支出方面的社会经济差异影响最大。
将登记和调查数据在个体层面进行关联，这些数据包括3个社会经济指标（收入、教育程度和财务福利）、26个社会决定因素、20种慢性病、年龄、性别、自评健康状况以及135,183名年龄在25至65岁之间的荷兰人的医疗保健支出。进行了奥克萨卡-布林德分解分析，以量化慢性病和社会决定因素对自评健康和医疗保健支出方面社会经济差异的相对贡献。
低收入群体中较差的自评健康状况和较高的医疗保健支出部分归因于慢性病的较高患病率（分别为33%和70%）。与酸相关的疾病、心血管疾病和心理障碍对自评健康和医疗保健支出的差异影响最大。社会决定因素几乎完全解释了自评健康方面的收入差异。社会决定因素对收入群体间医疗保健支出差异的解释超过了观察到的差异，这表明在调整社会决定因素后，低收入群体的医疗保健支出将低于高收入群体。在单一分解中纳入慢性病和社会决定因素表明，收入保障与社会保护（28%）、社会与人力资本（26%）以及慢性病（23%）对自评健康方面的收入差异同样重要。对于医疗保健支出，慢性病和社会决定因素各自约占社会经济差异的一半。
医疗保健部门之外的社会决定因素几乎解释了自评健康方面的所有社会经济差异。这凸显了需要在多个领域，如社会、经济和医疗保健部门实施综合政策，以减少可避免的健康不平等。鉴于医疗保健支出方面的社会经济差异主要与慢性病相关，在社会经济地位较低的群体中优先预防慢性病可能会降低该群体的医疗保健支出，并提高医疗保健系统的可持续性和可承受性。
