Income inequalities in the risk of potentially avoidable hospitalisation for chronic obstructive pulmonary disease

Nicholas Quinn,Neeru Gupta

doi:10.23889/ijpds.v5i1.1388

Abstract

IntroductionHospitalizations for ambulatory care sensitive conditions, of which chronic obstructive pulmonary disease (COPD) is among the most common, represent an indirect measure of the healthcare system to manage chronic disease. Research has pointed to disparities in various COPD-related outcomes between persons of lower versus higher income; however, few studies have examined the influence of patients’ social context on potentially avoidable COPD admissions.ObjectiveThe research explores the use of linked population census and administrative health data to assess the influence of income inequalities on the risk of hospitalization and rehospitalization for COPD among Canadian adults.MethodsThis analysis utilizes data from the 2006 Census linked longitudinally to the 2006/07-2008/09 Discharge Database. Multiple logistic regressions were conducted to assess the independent influence of income inequality on the risks of hospitalization and of six-month readmission due to COPD among the population aged 30-69, controlling for age, sex, education and other sociodemographic characteristics.ResultsCompared with adults in the most affluent income quintile, the adjusted odds of COPD hospitalization were significantly greater in the 4th highest income quintile (OR: 1.38; 95%CI: 1.30–1.47), and peaked for those in the least affluent quintile (OR: 2.92; 95%CI: 2.77–3.09). Among individuals who had been hospitalized at least once for COPD in the study period, and compared with the most affluent group, the adjusted odds of readmission were highest in the least affluent group (OR: 1.39; 95%CI: 1.22–1.58).ConclusionsDespite Canada’s system of universal coverage for physician and hospital care, a clear income gradient in the risk of being hospitalized and, to some extent, rehospitalized for COPD, is found. Income inequalities may be contributing to excess hospitalizations, reinforcing the importance of integrating social and economic issues in primary care to meet the ambulatory needs of this population.

Highlights

Hospitalizations for ambulatory care sensitive conditions, of which chronic obstructive pulmonary disease (COPD) is among the most common, represent an indirect measure of the healthcare system to manage chronic disease
Income inequalities may be contributing to excess hospitalizations, reinforcing the importance of integrating social and economic issues in primary care to meet the ambulatory needs of this population
Canadians in the least affluent income groups are more likely to be hospitalized for COPD and to be readmitted following discharge compared with the most affluent group, after adjusting for other sociodemographic factors, and this despite Canada’s system of publiclyfunded universal coverage for physician and hospital services

Summary

Introduction

Hospitalizations for ambulatory care sensitive conditions, of which chronic obstructive pulmonary disease (COPD) is among the most common, represent an indirect measure of the healthcare system to manage chronic disease. In the Canadian context, primary care physician services are universally accessible based on medical need rather than ability to pay through the stipulation of the Canada Health Act, and should be resistant to income inequalities, the equality of accessing primary care services may be amenable to improvements if there exists differential levels of access based on income The effects of these unequal health outcomes for persons with COPD are experienced as reduced levels of breathing capabilities, decreased ability for the individual to leave home, and increased difficulty with activities of daily living, all of which may contribute to acute needs requiring hospitalizations if primary care services are not available, accessible and acceptable [2, 7]. Studies have pointed to persistent and increasing income-related disparities in COPD mortality [11]

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