Educational differences in long-term care use in Sweden during the last two years of life.

Susanne Kelfve,Bettina Meinow,Jonas W Wastesson

doi:10.1177/14034948211043658

Abstract

Background: In old age, many people experience a period of functional decline and require long-term care. Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. Methods: We used linked register data on mortality and long-term care use, including all adults aged ⩾67 years who died in Sweden in November 2015 (N=6329). We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Men and women were analysed separately. Results: People with tertiary education died more commonly without using any long-term care compared to primary educated people (28.0% vs. 18.6%; p<0.001). In the adjusted model, educational differences in the estimated number of months with long-term care disappeared among men but remained significant among women (primary educated: odds ratio=17.3 (confidence interval 16.8-17.7); tertiary educated: odds ratio=15.8 (confidence interval 14.8-16.8)). Conclusions: Older adults spend considerable time in their last two years of life with long-term care. Only minor educational differences in long-term care use remained after adjustment for cohabitation status and age at death. This suggest that Sweden's publicly financed long-term system achieves relatively equitable use of long-term care at the end of life.

Highlights

Most deaths in low-mortality countries occur around 85–90 years of age [1,2] and are preceded by a period of functional decline and need for long-term care [3,4]
A study conducted in the UK, Italy, Belgium and the Netherlands found a socio-economic gradient in the use of formal and informal home-care services for older people, which was largely explained by age, health and marital status [11]
We considered the role of sex, cohabitation status and age at death – factors that have been shown to be associated with longterm care use in Finland [17] and Sweden [18]

Summary

Introduction

Most deaths in low-mortality countries occur around 85–90 years of age [1,2] and are preceded by a period of functional decline and need for long-term care [3,4]. Few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Educational differences in the estimated number of months with long-term care disappeared among men but remained significant among women (primary educated: odds ratio=17.3 (confidence interval 16.8–17.7); tertiary educated: odds ratio=15.8 (confidence interval 14.8–16.8)). Minor educational differences in long-term care use remained after adjustment for cohabitation status and age at death. This suggest that Sweden’s publicly financed long-term system achieves relatively equitable use of long-term care at the end of life

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