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. 2022 Apr 1;5(4):e226398.
doi: 10.1001/jamanetworkopen.2022.6398.

Socioeconomic Inequalities in Elective and Nonelective Hospitalizations in Older Men

Peiyao Xu  1 , Fiona M Blyth  1   2 , Vasi Naganathan  3   4   5 , Robert G Cumming  1   2 , David J Handelsman  6 , Markus J Seibel  6 , David G Le Couteur  4   5   6 , Louise M Waite  3   4   5 , Saman Khalatbari-Soltani  1   2
Affiliations

Socioeconomic Inequalities in Elective and Nonelective Hospitalizations in Older Men

Peiyao Xu et al. JAMA Netw Open. .

Abstract

Importance: Among older adults, there is limited and inconsistent evidence on the association between socioeconomic position (SEP) and elective and nonelective hospitalization.

Objective: To evaluate the association between SEP and all-cause and cause-specific elective and nonelective hospitalization and hospital length of stay among older men.

Design, setting, and participants: This population-based, prospective cohort study used data from the Concord Health and Aging in Men Project (CHAMP). CHAMP recruited 1705 men aged 70 years or older between January 28, 2005, and June 4, 2007, in Sydney, Australia. Data were analyzed from February 1 to September 30, 2021.

Exposures: Indicators of SEP, including education (university degree certificate, diploma or no postschool qualifications), occupation (professionals and managers; small employers and self-employed; or lower clerical, service, sales workers, skilled, and unskilled workers), and source of income (other sources of income than government pension, reliance on government pensions and other sources of income, or reliant solely on a government pension), and a cumulative SEP score (tertiles) as SEP indicators; 3-level variables present high, intermediate, and low SEP.

Main outcomes and measures: All-cause and cause-specific elective and nonelective hospitalizations, number of hospitalizations, and length of stay were the study outcomes, ascertained through data linkage. Associations were quantified using competing-risks survival regression and negative binomial regression.

Results: A total of 1566 men (mean [SD] age, 76.8 [5.4] years) were included. During a mean (SD) 9.07 (3.53) years of follow-up, 1067 men had at least 1 elective hospitalization, and 1255 men had at least 1 nonelective hospitalization. No associations were found between SEP and elective hospitalizations. Being in the lowest tertile for educational level (subhazard ratio [SHR], 1.32; 95% CI, 1.11-1.58), occupational position (SHR, 1.30; 95% CI, 1.12-1.50), sources of income (SHR, 1.33; 95% CI, 1.17-1.52), and cumulative SEP tertile groups (SHR, 1.45; 95% CI, 1.24-1.68) were all associated with having at least 1 nonelective hospitalization compared with those in the highest tertiles. Significant associations were found between being in the lowest SEP groups and increased numbers and longer length of stay of nonelective hospitalizations.

Conclusions and relevance: In this prospective cohort study, low SEP was inversely associated with nonelective hospitalizations but not elective hospitalization in older men in Australia. These findings point to the existence of socioeconomic inequalities in health care use, indicative of a need to take action to reduce these inequalities.

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Conflict of interest statement

Conflict of Interest Disclosures: Prof Seibel reported receiving grants from the National Health and Medical Research Council of Australia during the conduct of the study. Prof Waite reported receiving grants from the National Health and Medical Research Council of Australia during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Association of Socioeconomic Indicators With Having at Least 1 Elective or Nonelective Hospitalization Among 1566 Participants
Calendar year was used as the time scale, with survivors having a censoring date of December 31, 2017, for elective hospitalization (8189 person-years of follow-up) and nonelective hospitalization (8282 person-years of follow-up). All estimates were adjusted for age, age squared, country of birth, and marital status. SEP indicates socioeconomic position; SHR, subhazard ratio.
Figure 2.
Figure 2.. Association of Socioeconomic Indicators With Number of Elective and Nonelective Hospitalizations
Overall, the total number of elective hospitalizations was 2871 and nonelective hospitalization was 5102. All estimates were adjusted for age, age squared, country of birth, and marital status. RR indicates rate ratio; SEP, socioeconomic position.
Figure 3.
Figure 3.. Association of Socioeconomic Indicators With Length of Stay of First Elective and Nonelective Hospitalization
All estimates were adjusted for age, age squared, country of birth, and marital status. LOS indicates length of stay; RR, rate ratio; and SEP, socioeconomic position.
Figure 4.
Figure 4.. Association of Socioeconomic Indicators With Cumulative Length of Stay of Elective and Nonelective Hospitalizations
All estimates were adjusted for age, age squared, country of birth, and marital status. LOS indicates length of stay; RR, rate ratio; and SEP, socioeconomic position.
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