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Socioeconomic differences in childhood hospital inpatient service utilisation and costs: prospective cohort study
1National Perinatal Epidemiology Unit, University of Oxford (Old Road Campus), Old Road, Headington, Oxford OX3 7LF, UK. stavros.petrou@npeu.ox.ac.uk
Insights
Children from lower socioeconomic positions experienced higher hospital use and costs in their first decade. This highlights the need for targeted health interventions for disadvantaged populations.
Area of Science:
- Pediatric Health Services Research
- Social Epidemiology
- Health Economics
Background:
- Socioeconomic position at birth is a critical determinant of child health outcomes.
- Understanding the long-term impact on healthcare utilization is essential for public health planning.
Purpose of the Study:
- To investigate the association between socioeconomic status (SES) at birth and hospital inpatient service use and costs.
- To analyze healthcare utilization patterns during the first 10 years of life based on parental SES.
Main Methods:
- Analysis of a large linked database of birth registrations, hospital records, and death certificates.
- Multilevel multiple regression modeling to assess associations between social class and healthcare utilization.
- Inclusion of 117,212 children born in Oxfordshire and West Berkshire between 1979 and 1988.
Main Results:
- Children born into lower social classes (II-V) had significantly higher rates of hospital admission, longer hospital stays, and greater inpatient costs compared to those in social class I.
- Adjusted analyses showed increased odds of admission (1.27), days (1.20), and costs (1.50) for children in the lowest social class (V) versus class I.
- The disparities in hospital use and costs were more pronounced between ages 3-10 years than in the first two years of life.
Conclusions:
- Socioeconomic disadvantage at birth has significant, lasting effects on children's hospital inpatient service utilization and associated costs.
- Healthcare decision-makers must consider these socioeconomic gradients when planning child health services.
- Targeted prevention interventions are crucial for mitigating the adverse health sequelae of socioeconomic disadvantage in children.
Study Objective:
To examine the association between socioeconomic position at the time of birth and the use and cost of hospital inpatient services during the first 10 years of life.
Design:
Analysis of a database of linked birth registrations, hospital records, and death certificates. Associations between the social class of the head of household and hospital inpatient service utilisation and costs during the first 10 years of life were analysed using multilevel multiple regression modelling.
Participants And Setting:
All 117 212 children born to women who both lived and delivered in hospital in Oxfordshire or West Berkshire, southern England, during the period 1 January 1979 to 31 December 1988.
Main Results:
The study showed that children born into social classes II, III-NM, III-M, IV, and V were more likely to be admitted to hospital, spend longer in hospital overall, and generate greater hospital costs than children born into social class I. The adjusted effect regarding hospital inpatient admissions, days, and costs was 1.27 (95% CI: 1.26, 1.27), 1.20 (1.19, 1.21), and 1.50 (1.49, 1.53), respectively, for children born into social class V when compared with children born into social class I. The impact of social class on hospital inpatient admissions, days, and costs was most acutely felt during years 3-10 of life as compared with the first two years of life.
Conclusions:
Health service decision makers need to be alert to the adverse sequelae that might result from socioeconomic disadvantage when planning health services for children. Particular attention should be paid to targeting deprived populations with prevention interventions that are known to be effective.
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