IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0272265.html

Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland

Author

Listed:
  • Lucy Bayer-Oglesby
  • Andrea Zumbrunn
  • Nicole Bachmann
  • on behalf of the SIHOS Team

Abstract

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.

Suggested Citation

  • Lucy Bayer-Oglesby & Andrea Zumbrunn & Nicole Bachmann & on behalf of the SIHOS Team, 2022. "Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland," PLOS ONE, Public Library of Science, vol. 17(8), pages 1-30, August.
    • Handle: RePEc:plo:pone00:0272265
    DOI: 10.1371/journal.pone.0272265
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0272265
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0272265&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0272265?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Aigner, Dennis J., 1973. "Regression with a binary independent variable subject to errors of observation," Journal of Econometrics, Elsevier, vol. 1(1), pages 49-59, March.
    2. Weaver, France M. & Weaver, Bryce A., 2014. "Does availability of informal care within the household impact hospitalisation?," Health Economics, Policy and Law, Cambridge University Press, vol. 9(1), pages 71-93, January.
    3. repec:plo:pmed00:1001885 is not listed on IDEAS
    4. AIGNER, Dennis J., 1973. "Regression with a binary independent variable subject to errors of observation," LIDAM Reprints CORE 130, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    5. repec:plo:pmed00:0040297 is not listed on IDEAS
    6. Simon Wieser & Marco Riguzzi & Mark Pletscher & Carola A. Huber & Harry Telser & Matthias Schwenkglenks, 2018. "How much does the treatment of each major disease cost? A decomposition of Swiss National Health Accounts," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(8), pages 1149-1161, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Adele Bergin, 2015. "Employer Changes and Wage Changes: Estimation with Measurement Error in a Binary Variable," LABOUR, CEIS, vol. 29(2), pages 194-223, June.
    2. Santiago Acerenza & Kyunghoon Ban & D'esir'e K'edagni, 2021. "Local Average and Marginal Treatment Effects with a Misclassified Treatment," Papers 2105.00358, arXiv.org, revised Sep 2024.
    3. Charles Courtemanche & Augustine Denteh & Rusty Tchernis, 2019. "Estimating the Associations between SNAP and Food Insecurity, Obesity, and Food Purchases with Imperfect Administrative Measures of Participation," Southern Economic Journal, John Wiley & Sons, vol. 86(1), pages 202-228, July.
    4. Miaari, Sami H. & Lee, Ines, 2020. "Obstacles on the Road to School: The Impacts of Mobility Restrictions on Educational Performance," IZA Discussion Papers 13563, IZA Network @ LISER.
    5. Marianne Page, 2006. "Father's Education and Children's Human Capital: Evidence from the World War II GI Bill," Working Papers 84, University of California, Davis, Department of Economics.
    6. Holmlund, Helena, 2007. "A Researcher's Guide to the Swedish Compulsory School Reform," Working Paper Series 9/2007, Stockholm University, Swedish Institute for Social Research.
    7. Gittleman Maury, 2011. "Medicaid and Wealth: A Re-Examination," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 11(1), pages 1-25, November.
    8. Craig Gundersen & Brent Kreider, 2008. "Food Stamps and Food Insecurity: What Can Be Learned in the Presence of Nonclassical Measurement Error?," Journal of Human Resources, University of Wisconsin Press, vol. 43(2), pages 352-382.
    9. Kreider, Brent & Pepper, John V., 2007. "Disability and Employment: Reevaluating the Evidence in Light of Reporting Errors," Journal of the American Statistical Association, American Statistical Association, vol. 102, pages 432-441, June.
    10. Kaestner, Robert & Joyce, Theodore & Wehbeh, Hassan, 1996. "The Effect of Maternal Drug Use on Birth Weight: Measurement Error in Binary Variables," Economic Inquiry, Western Economic Association International, vol. 34(4), pages 617-629, October.
    11. repec:pri:cepsud:136mastrobuoni is not listed on IDEAS
    12. Gerdtham, Ulf-G & Lundborg, Petter & Lyttkens, Carl Hampus & Nystedt, Paul, 2012. "Do Socioeconomic Factors Really Explain Income-Related Inequalities in Health? Applying a Twin Design to Standard Decomposition Analysis," Working Papers 2012:21, Lund University, Department of Economics.
    13. Violeta Misheva & Dinand Webbink & Nicholas G. Martin, 2017. "The effect of child maltreatment on illegal and problematic behaviour: new evidence on the ‘cycle of violence’ using twins data," Journal of Population Economics, Springer;European Society for Population Economics, vol. 30(4), pages 1035-1067, October.
    14. Frazis, Harley & Loewenstein, Mark A., 2003. "Estimating linear regressions with mismeasured, possibly endogenous, binary explanatory variables," Journal of Econometrics, Elsevier, vol. 117(1), pages 151-178, November.
    15. Philip Oreopoulos & Marianne E. Page, 2006. "The Intergenerational Effects of Compulsory Schooling," Journal of Labor Economics, University of Chicago Press, vol. 24(4), pages 729-760, October.
    16. Seah, Kelvin KC, 2018. "Immigrant educators and students’ academic achievement," Labour Economics, Elsevier, vol. 51(C), pages 152-169.
    17. Diwan, Ishac & Jamal Ibrahim Haidar, "undated". "Do Political Connections Reduce Job Creation? Evidence from Lebanon," Working Paper 414186, Harvard University OpenScholar.
    18. Carlos Lapuerta & Juan Benavides & Sonia Jorge, 2003. "Regulation and Competition in Mobile Telephony in Latin America," Research Department Publications 1001, Inter-American Development Bank, Research Department.
    19. Wossen, Tesfamicheal & Abay, Kibrom A. & Abdoulaye, Tahirou, 2022. "Misperceiving and misreporting input quality: Implications for input use and productivity," Journal of Development Economics, Elsevier, vol. 157(C).
    20. Robert Kaestner & Benjamin Yarnoff, 2011. "Long-Term Effects of Minimum Legal Drinking Age Laws on Adult Alcohol Use and Driving Fatalities," Journal of Law and Economics, University of Chicago Press, vol. 54(2), pages 325-363.
    21. Erich Battistin & Barbara Sianesi, 2006. "Misreported schooling and returns to education: evidence from the UK," CeMMAP working papers CWP07/06, Centre for Microdata Methods and Practice, Institute for Fiscal Studies.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0272265. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.