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Income-based differences in healthcare utilization in relation to mortality in the Swedish population between 2004–2017: A nationwide register study

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  • Pär Flodin
  • Peter Allebeck
  • Ester Gubi
  • Bo Burström
  • Emilie E Agardh

Abstract

Background: Despite universal healthcare, socioeconomic differences in healthcare utilization (HCU) persist in modern welfare states. However, little is known of how HCU inequalities has developed over time. The aim of this study is to assess time trends of differences in utilization of primary and specialized care for the lowest (Q1) and highest (Q5) income quantiles and compare these to mortality. Methods and findings: Using a repeated cross-sectional register-based study design, data on utilization of (i) primary; (ii) specialized outpatient; and (iii) inpatient care, as well as (iv) cause of death, were linked to family income and sociodemographic control variables (for instance, country of origin and marital status). The study sample comprised all individuals 16 years or older residing in Sweden any year during the study period and ranged from 7.1 million in year 2004 to 8.0 million year 2017. HCU and mortality for all disease as well as for the 5 disease groups causing most deaths were compared for the Q1 and Q5 using logistic regression, adjusting for sex, age, marital status, and birth country. The primary outcome measures were adjusted odds ratios (ORs), and regression coefficients of annual changes in these ORs log-transformed. Additionally, we conducted negative binominal regression to calculate adjusted rate ratios (RRs) comparing Q1 and Q5 with regard to number of disease specific healthcare encounters ≤5 years prior to death. Conclusions: Income-related differences in the utilization of primary and specialized outpatient care were considerably smaller than for mortality, and this discrepancy widened with time. Facilitating motivated use of primary and outpatient care among low-income groups could help mitigate the growing health inequalities. In this cohort study conducted in Sweden, Pär Flodin and colleagues, investigate how income influences healthcare utilisation and mortality.Why was this study done?: What did the researchers do and find?: What do these findings mean?:

Suggested Citation

  • Pär Flodin & Peter Allebeck & Ester Gubi & Bo Burström & Emilie E Agardh, 2023. "Income-based differences in healthcare utilization in relation to mortality in the Swedish population between 2004–2017: A nationwide register study," PLOS Medicine, Public Library of Science, vol. 20(11), pages 1-17, November.
    • Handle: RePEc:plo:pmed00:1004230
    DOI: 10.1371/journal.pmed.1004230
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    1. Alessio Petrelli & Anteo Di Napoli & Elena Demuru & Martina Ventura & Roberto Gnavi & Lidia Di Minco & Cristina Tamburini & Concetta Mirisola & Gabriella Sebastiani, 2020. "Socioeconomic and citizenship inequalities in hospitalisation of the adult population in Italy," PLOS ONE, Public Library of Science, vol. 15(4), pages 1-11, April.
    2. Burstrom, Bo, 2002. "Increasing inequalities in health care utilisation across income groups in Sweden during the 1990s?," Health Policy, Elsevier, vol. 62(2), pages 117-129, November.
    3. Terraneo, Marco, 2015. "Inequities in health care utilization by people aged 50+: Evidence from 12 European countries," Social Science & Medicine, Elsevier, vol. 126(C), pages 154-163.
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