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Socioeconomic variation in the burden of chronic conditions and health care provision--analyzing administrative individual level data from the Basque Country, Spain.

Orueta JF, García-Álvarez A, Alonso-Morán E, Vallejo-Torres L, Nuño-Solinis R - BMC Public Health (2013)

Bottom Line: Although the existence of a socioeconomic health gradient is one of the main concerns of health policy across the world, health information systems commonly do not have reliable data to detect and monitor health inequalities and inequities.However, even after accounting for differences in morbidity, pro-poor horizontal inequity was present in specialized outpatient care, emergency department, prescription, and primary health care costs and this fact was more apparent in females than males; inpatient costs exhibited an equitable distribution in both sexes.This frequently updated source of information can be exploited to monitor trends and evaluate the impact of policy reforms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Oberri (The Basque Institute for Health Innovation), Sondika, Bizkaia, Spain. jon.orueta@osakidetza.net.

ABSTRACT

Background: Chronic diseases are posing an increasing challenge to society, with the associated burden falling disproportionally on more deprived individuals and geographical areas. Although the existence of a socioeconomic health gradient is one of the main concerns of health policy across the world, health information systems commonly do not have reliable data to detect and monitor health inequalities and inequities. The objectives of this study were to measure the level of socioeconomic-related inequality in prevalence of chronic diseases and to investigate the extent and direction of inequities in health care provision.

Methods: A dataset linking clinical and administrative information of the entire population living in the Basque Country, Spain (over 2 million individuals) was used to measure the prevalence of 52 chronic conditions and to quantify individual health care costs. We used a concentration-index approach to measure the extent and direction of inequality with respect to the deprivation of the area of residence of each individual.

Results: Most chronic diseases were found to be disproportionally concentrated among individuals living in more deprived areas, but the extent of the imbalance varies by type of disease and sex. Most of the variation in health care utilization was explained by morbidity burden. However, even after accounting for differences in morbidity, pro-poor horizontal inequity was present in specialized outpatient care, emergency department, prescription, and primary health care costs and this fact was more apparent in females than males; inpatient costs exhibited an equitable distribution in both sexes.

Conclusions: Analyses of comprehensive administrative clinical information at the individual level allow the socioeconomic gradient in chronic diseases and health care provision to be measured to a level of detail not possible using other sources. This frequently updated source of information can be exploited to monitor trends and evaluate the impact of policy reforms.

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Socioeconomic-related inequality in age-adjusted multimorbidity by sex.
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Figure 2: Socioeconomic-related inequality in age-adjusted multimorbidity by sex.

Mentions: Figure 2 shows the level of socioeconomic inequality in multimorbidity by sex. The results indicate that, after controlling for age, individuals living in more deprived areas had disproportionally more comorbidities than those living in less deprived areas. The extent of inequality observed increased when we defined multimorbidity by the presence of an increasingly larger number of diseases. In every case, there was greater inequality among females than males.


Socioeconomic variation in the burden of chronic conditions and health care provision--analyzing administrative individual level data from the Basque Country, Spain.

Orueta JF, García-Álvarez A, Alonso-Morán E, Vallejo-Torres L, Nuño-Solinis R - BMC Public Health (2013)

Socioeconomic-related inequality in age-adjusted multimorbidity by sex.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3852590&req=5

Figure 2: Socioeconomic-related inequality in age-adjusted multimorbidity by sex.
Mentions: Figure 2 shows the level of socioeconomic inequality in multimorbidity by sex. The results indicate that, after controlling for age, individuals living in more deprived areas had disproportionally more comorbidities than those living in less deprived areas. The extent of inequality observed increased when we defined multimorbidity by the presence of an increasingly larger number of diseases. In every case, there was greater inequality among females than males.

Bottom Line: Although the existence of a socioeconomic health gradient is one of the main concerns of health policy across the world, health information systems commonly do not have reliable data to detect and monitor health inequalities and inequities.However, even after accounting for differences in morbidity, pro-poor horizontal inequity was present in specialized outpatient care, emergency department, prescription, and primary health care costs and this fact was more apparent in females than males; inpatient costs exhibited an equitable distribution in both sexes.This frequently updated source of information can be exploited to monitor trends and evaluate the impact of policy reforms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Oberri (The Basque Institute for Health Innovation), Sondika, Bizkaia, Spain. jon.orueta@osakidetza.net.

ABSTRACT

Background: Chronic diseases are posing an increasing challenge to society, with the associated burden falling disproportionally on more deprived individuals and geographical areas. Although the existence of a socioeconomic health gradient is one of the main concerns of health policy across the world, health information systems commonly do not have reliable data to detect and monitor health inequalities and inequities. The objectives of this study were to measure the level of socioeconomic-related inequality in prevalence of chronic diseases and to investigate the extent and direction of inequities in health care provision.

Methods: A dataset linking clinical and administrative information of the entire population living in the Basque Country, Spain (over 2 million individuals) was used to measure the prevalence of 52 chronic conditions and to quantify individual health care costs. We used a concentration-index approach to measure the extent and direction of inequality with respect to the deprivation of the area of residence of each individual.

Results: Most chronic diseases were found to be disproportionally concentrated among individuals living in more deprived areas, but the extent of the imbalance varies by type of disease and sex. Most of the variation in health care utilization was explained by morbidity burden. However, even after accounting for differences in morbidity, pro-poor horizontal inequity was present in specialized outpatient care, emergency department, prescription, and primary health care costs and this fact was more apparent in females than males; inpatient costs exhibited an equitable distribution in both sexes.

Conclusions: Analyses of comprehensive administrative clinical information at the individual level allow the socioeconomic gradient in chronic diseases and health care provision to be measured to a level of detail not possible using other sources. This frequently updated source of information can be exploited to monitor trends and evaluate the impact of policy reforms.

Show MeSH
Related in: MedlinePlus