Evolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditions
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.1186/s12939-017-0642-7 |
Resumo: | Background: Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are specific conditions for which hospitalization is thought to be avoidable through patient education, health promotion initiatives, early diagnosis and by appropriate chronic disease management, and have been shown to be greatly influenced by socioeconomic (SE) characteristics. We examined the SE inequalities in hospitalization rates for ACSC in Portugal, their evolution over time (2000-2014), and their associated financial burden. Methods: We modeled municipality-level ACSC hospitalization rates per 1000 inhabitants and ACSC hospitalization-related costs per inhabitant, for the 2000-2014 period (n = 4170), as a function of SE indicators (illiteracy and purchasing power, in quintiles), controlling for the proportion of elderly, sex, disease specific mortality rate, population density, PC supply, and time trend. The evolution of inequalities was measured interacting SE indicators with a time trend. Costs attributable to ACSC related hospitalization inequalities were measured by the predicted values for each quintile of the SE indicators. Results: Hospitalization rate for ACSC was significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 1.97; p < 0.01), and significantly lower in the 5th quintile of purchasing power, compared with the 1st quintile (beta = - 1.19; p < 0.05). ACSC hospitalization-related costs were also significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 4.04€; p < 0.05), and significantly lower in the 5th quintile of purchasing power, compared with the 1st quintile (beta = - 4,69€; p < 0.01). The SE gradient significantly increased over the 2000-2014 period, and the annual cost of inequalities were estimated at more than 15 million euros for the Portuguese NHS. Conclusion: There was an increasing SE patterning in ACSC related hospitalizations, possibly reflecting increasing SE inequalities in early and preventive high-quality care, imposing a substantial financial burden to the Portuguese NHS. |
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Evolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditionsan ecological study for Portugal, 2000-2014Ambulatory care sensitive conditionsCostsPrimary careSocioeconomic inequalitiesHealth PolicyPublic Health, Environmental and Occupational HealthSDG 3 - Good Health and Well-beingBackground: Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are specific conditions for which hospitalization is thought to be avoidable through patient education, health promotion initiatives, early diagnosis and by appropriate chronic disease management, and have been shown to be greatly influenced by socioeconomic (SE) characteristics. We examined the SE inequalities in hospitalization rates for ACSC in Portugal, their evolution over time (2000-2014), and their associated financial burden. Methods: We modeled municipality-level ACSC hospitalization rates per 1000 inhabitants and ACSC hospitalization-related costs per inhabitant, for the 2000-2014 period (n = 4170), as a function of SE indicators (illiteracy and purchasing power, in quintiles), controlling for the proportion of elderly, sex, disease specific mortality rate, population density, PC supply, and time trend. The evolution of inequalities was measured interacting SE indicators with a time trend. Costs attributable to ACSC related hospitalization inequalities were measured by the predicted values for each quintile of the SE indicators. Results: Hospitalization rate for ACSC was significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 1.97; p < 0.01), and significantly lower in the 5th quintile of purchasing power, compared with the 1st quintile (beta = - 1.19; p < 0.05). ACSC hospitalization-related costs were also significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 4.04€; p < 0.05), and significantly lower in the 5th quintile of purchasing power, compared with the 1st quintile (beta = - 4,69€; p < 0.01). The SE gradient significantly increased over the 2000-2014 period, and the annual cost of inequalities were estimated at more than 15 million euros for the Portuguese NHS. Conclusion: There was an increasing SE patterning in ACSC related hospitalizations, possibly reflecting increasing SE inequalities in early and preventive high-quality care, imposing a substantial financial burden to the Portuguese NHS.Escola Nacional de Saúde Pública (ENSP)Centro de Investigação em Saúde Pública (CISP/PHRC)RUNDimitrovová, KláraCosta, CláudiaSantana, PaulaPerelman, Julian2018-02-07T23:11:40Z2017-08-162017-08-16T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article11application/pdfhttps://doi.org/10.1186/s12939-017-0642-7eng1475-9276PURE: 3198070http://www.scopus.com/inward/record.url?scp=85027516523&partnerID=8YFLogxKhttps://doi.org/10.1186/s12939-017-0642-7info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T04:16:28Zoai:run.unl.pt:10362/30029Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:29:22.709724Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Evolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditions an ecological study for Portugal, 2000-2014 |
title |
Evolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditions |
spellingShingle |
Evolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditions Dimitrovová, Klára Ambulatory care sensitive conditions Costs Primary care Socioeconomic inequalities Health Policy Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
title_short |
Evolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditions |
title_full |
Evolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditions |
title_fullStr |
Evolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditions |
title_full_unstemmed |
Evolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditions |
title_sort |
Evolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditions |
author |
Dimitrovová, Klára |
author_facet |
Dimitrovová, Klára Costa, Cláudia Santana, Paula Perelman, Julian |
author_role |
author |
author2 |
Costa, Cláudia Santana, Paula Perelman, Julian |
author2_role |
author author author |
dc.contributor.none.fl_str_mv |
Escola Nacional de Saúde Pública (ENSP) Centro de Investigação em Saúde Pública (CISP/PHRC) RUN |
dc.contributor.author.fl_str_mv |
Dimitrovová, Klára Costa, Cláudia Santana, Paula Perelman, Julian |
dc.subject.por.fl_str_mv |
Ambulatory care sensitive conditions Costs Primary care Socioeconomic inequalities Health Policy Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
topic |
Ambulatory care sensitive conditions Costs Primary care Socioeconomic inequalities Health Policy Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
description |
Background: Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are specific conditions for which hospitalization is thought to be avoidable through patient education, health promotion initiatives, early diagnosis and by appropriate chronic disease management, and have been shown to be greatly influenced by socioeconomic (SE) characteristics. We examined the SE inequalities in hospitalization rates for ACSC in Portugal, their evolution over time (2000-2014), and their associated financial burden. Methods: We modeled municipality-level ACSC hospitalization rates per 1000 inhabitants and ACSC hospitalization-related costs per inhabitant, for the 2000-2014 period (n = 4170), as a function of SE indicators (illiteracy and purchasing power, in quintiles), controlling for the proportion of elderly, sex, disease specific mortality rate, population density, PC supply, and time trend. The evolution of inequalities was measured interacting SE indicators with a time trend. Costs attributable to ACSC related hospitalization inequalities were measured by the predicted values for each quintile of the SE indicators. Results: Hospitalization rate for ACSC was significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 1.97; p < 0.01), and significantly lower in the 5th quintile of purchasing power, compared with the 1st quintile (beta = - 1.19; p < 0.05). ACSC hospitalization-related costs were also significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 4.04€; p < 0.05), and significantly lower in the 5th quintile of purchasing power, compared with the 1st quintile (beta = - 4,69€; p < 0.01). The SE gradient significantly increased over the 2000-2014 period, and the annual cost of inequalities were estimated at more than 15 million euros for the Portuguese NHS. Conclusion: There was an increasing SE patterning in ACSC related hospitalizations, possibly reflecting increasing SE inequalities in early and preventive high-quality care, imposing a substantial financial burden to the Portuguese NHS. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-08-16 2017-08-16T00:00:00Z 2018-02-07T23:11:40Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.1186/s12939-017-0642-7 |
url |
https://doi.org/10.1186/s12939-017-0642-7 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
1475-9276 PURE: 3198070 http://www.scopus.com/inward/record.url?scp=85027516523&partnerID=8YFLogxK https://doi.org/10.1186/s12939-017-0642-7 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
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11 application/pdf |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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