| 1. |
- Agerholm, J, et al.
(författare)
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Socioeconomic differences in healthcare utilization, with and without adjustment for need: an example from Stockholm, Sweden
- 2013
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 41:3, s. 318-325
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Previous studies have shown varying degrees of inequity of utilization of healthcare in Sweden. Studies based solely on register data cannot take into account differences in health status while studies based solely on self-reported data from surveys may potentially have biased data on healthcare utilization. The aim of this study was to investigate socioeconomic differences in utilization of outpatient healthcare services in Stockholm County, comparing analysis based on only register data, with analysis based on health survey data linked to register data. Methods: We linked data from a public health survey in Stockholm County 2006 ( n = 34,707) to register data on sociodemographic background characteristics and outpatient healthcare utilization in 2007. Negative binomial regression analysis was used to estimate income differentials in healthcare utilization adjusting for self-rated health and limiting longstanding illness. Results: Income differentials in the number of visits to doctors were found in favour of lower-income groups among people aged 25–64 years when only controlling for age. When controlling for health status, income differentials in favour of higher-income groups were observed among men (all ages) and among women aged 65+ years, with higher-income groups having 11–49% more visits than the lowest income group. Conclusions: The findings suggest that health status should be taken into account when analysing socioeconomic differences in healthcare utilization. When using only register based data there is a risk of underestimating or disregarding differences.
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| 2. |
- Beijer, U, et al.
(författare)
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Changes over time in the risk of hospitalization for physical diseases among homeless men and women in Stockholm: A comparison of two cohorts
- 2016
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 44:8, s. 784-790
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To follow-up hospitalization for physical diseases among homeless men and women compared with a control group from the general population. The study also investigated the changes in the difference between the homeless men and women and the general population over time by comparing two cohorts of homeless people (2000–2002 and 1996). Methods: A total of 3887 people (24% women) who were homeless during the period 2000–2002 were compared with 11,661 people from the general population with respect to hospitalization for physical diseases and injuries (2000–2010). Indirect comparisons were used to compare the relative risk (RR) of hospitalization between the cohort of people who were homeless in 2000–2002 with a cohort of those who were homeless in 1996. Results: Homeless people have an RR of being hospitalized for physical diseases twice that of the general population. The largest differences were found in skin diseases, infections, injury/poisoning and diseases of the respiratory system. Indirect comparison between people who were homeless in 2000–2002 and 1996 showed an increasing difference between young (18–35 years) homeless men and men in the control group (RR 1.32). The difference had also increased between homeless men and men in the control group for hospitalization for heart disease (RR 1.35), chronic obstructive pulmonary disease (RR 2.60) and poisoning (RR 1.89). Among women, the difference had decreased between homeless women and women in the control group for skin disease (RR 0.20) and injury/poisoning (RR 0.60). There was no significant difference between the sexes in the two homeless cohorts. Conclusions: There was no improvement in excess hospitalization among homeless people over time. The difference between young homeless men and young men in the general population increased between 1996 and 2000–2002.
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| 3. |
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| 4. |
- Borrell, C, et al.
(författare)
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Socioeconomic inequalities in mortality in 16 European cities
- 2014
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 42:3, s. 245-254
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To explore inequalities in total mortality between small areas of 16 European cities for men and women, as well as to analyse the relationship between these geographical inequalities and their socioeconomic indicators. Methods: A cross-sectional ecological design was used to analyse small areas in 16 European cities (26,229,104 inhabitants). Most cities had mortality data for a period between 2000 and 2008 and population size data for the same period. Socioeconomic indicators included an index of socioeconomic deprivation, unemployment, and educational level. We estimated standardised mortality ratios and controlled for their variability using Bayesian models. We estimated relative risk of mortality and excess number of deaths according to socioeconomic indicators. Results: We observed a consistent pattern of inequality in mortality in almost all cities, with mortality increasing in parallel with socioeconomic deprivation. Socioeconomic inequalities in mortality were more pronounced for men than women, and relative inequalities were greater in Eastern and Northern European cities, and lower in some Western (men) and Southern (women) European cities. The pattern of excess number of deaths was slightly different, with greater inequality in some Western and Northern European cities and also in Budapest, and lower among women in Madrid and Barcelona. Conclusions: In this study, we report a consistent pattern of socioeconomic inequalities in mortality in 16 European cities. Future studies should further explore specific causes of death, in order to determine whether the general pattern observed is consistent for each cause of death.
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| 5. |
- Diez, E, et al.
(författare)
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Municipal interventions against inequalities in health: The view of their managers
- 2014
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 42:6, s. 476-487
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Tidskriftsartikel (refereegranskat)abstract
- Background: European city councils are increasingly developing interventions against health inequalities. There is little knowledge about how they are perceived. This study describes and analyses good practices and challenges for local interventions on inequalities in health through the narratives of European city managers. Methods: A qualitative study was conducted. Each participating city (Amsterdam, Barcelona, Cluj-Napoca, Helsinki, Lisbon, London, Madrid, Rotterdam) selected interventions following these criteria: at least 6 months of implementation; an evaluation performed or foreseen; the reduction of health inequalities among their objectives, and only one of the interventions selected could be based on health care. Managers of these local interventions were interviewed following an outline. Eleven individual in-depth interviews describing nine local interventions were obtained. A thematic content analysis was performed. Results: One or more local interventions against health inequalities were identified in each city. Most relied on quantitative data and were linked to national strategies. Few interventions addressed socio-economic determinants. Health care, employment and education were the main determinants addressed. With variable depth, evidence-base, participation and intersectorality were regular components of the interventions. Half of them targeted the city and half some deprived neighbourhoods. Few interventions had been evaluated. Scarcity of funding and sustainability of the projects were the main perceived barriers by the managers. Conclusions: City intervention managers were familiar with health inequalities and concepts as intersectorality, participation and evidence-based action, but others such as socioeconomic aims, gradient approach, evaluation and sustainability were not so widely applied. Managers’ capacities and political leadership in governance for health should be reinforced.
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| 6. |
- Holland, P, et al.
(författare)
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Socioeconomic inequalities in the employment impact of ischaemic heart disease: a longitudinal record linkage study in Sweden
- 2009
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 37:5, s. 450-458
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Low socioeconomic status is associated with increased risk of ischaemic heart disease (IHD) in many European and North American countries. We hypothesize that the adverse impact of having IHD may also be heavier in lower socioeconomic groups and may constitute a mechanism for generating or reinforcing social inequalities in health. Methods: Population registers of the 1.8 million residents of Stockholm County were used to assess the employment consequences over five years of having a diagnosis of IHD (600 cases) requiring hospital admission in 1996. We calculated annual age-standardized employment rates and age-adjusted odds of leaving employment during 1997—2001 by social class for in-patients and the general population. Results: Men and women who had an in-patient episode for IHD had lower age-standardized employment rates than the general population. Following hospital admission, the likelihood of patients with IHD leaving employment increased annually, and by 2001 their adjusted odds were almost four times greater (odds ratio 3.95, 95% confidence interval 3.23—4.83) than for the general population. The impact of IHD on employment was more severe with decreasing social class and patients employed in low-skilled manual occupations were significantly more likely to lose employment than professional workers with the same diagnosis. Within each social class patients had significantly higher odds of leaving employment than the general population. Conclusions: In spite of its progressive employment and rehabilitation policies, our study revealed considerable and socially differentiated employment consequences of IHD in Sweden. More account needs to be taken of such differential impact in health and social policy development.
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| 7. |
- Liljas, AEM, et al.
(författare)
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Opportunities for transitional care and care continuity following hospital discharge of older people in three Nordic cities: A comparative study
- 2024
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 52:1, s. 5-9
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Tidskriftsartikel (refereegranskat)abstract
- To outline and discuss care transitions and care continuity following hospital discharge of older people with complex care needs in three Nordic cities: Copenhagen, Tampere and Stockholm. Methods: Data on potential pathways following hospital discharge of older people were obtained from existing literature and expert consultations. The pathways for each system were outlined and presented in three figures. The hospital discharge process of the systems was then compared. Results: In all three care systems, the main care path from hospital is to home. Short-term intermediate healthcare can be provided in all three systems, possibly creating additional care transitions; however, once home, extensive home healthcare may prevent further care transitions. Opportunities for continuity of care include needs assessments (all cities) and meetings with the patient about care upon return home (Copenhagen, Stockholm). Yet this is challenged by lack of transfer of information (Tampere) and patients’ having to apply for some services themselves (Tampere, Stockholm). Conclusions: Comparisons of the discharge processes studied suggest that despite individual care planning and short- and long-term care options, transitional care and care continuity are challenged by limited access as some services need to be applied for by the older person themselves.
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| 8. |
- Lindholm, C, et al.
(författare)
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Does chronic illness cause adverse social and economic consequences among Swedes?
- 2001
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 29:1, s. 63-70
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Tidskriftsartikel (refereegranskat)abstract
- Background: In an international comparison, the Swedish welfare system has been known for universal coverage and high benefit levels. Perhaps this is the reason why very few studies recently have dealt with the social and economic consequences of long-term illness in Sweden. Aims: The research question raised here is therefore to examine chronic illness ( defined as limiting longstanding illness, LLSI) as a causal factor contributing adverse financial conditions, unemployment or labour market exclusion. Methods: A longitudinal design was employed with data from a sample of 27,773 people interviewed twice ( Swedish Surveys of Living Conditions performed by Statistics Sweden) , including subjects ( n=12,556) at interview I, without chronic illness or adverse socioeconomic conditions . Results: The odds ratios for labour market exclusion, unemployment, and financial difficulties among people who had acquired LLSI at interview II varied between 1.4 and 4.0 for the outcomes. The elevated OR decreased after testing for the mediating effect of social context and the labour market position for financial difficulties but remained significantly elevated. Conclusions: The results suggest that LLSI increases the risk of adverse financial conditions, unemployment, and of not being economically active.
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| 9. |
- Sun, S, et al.
(författare)
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Health-related quality of life (EQ-5D) among homeless persons compared to a general population sample in Stockholm County, 2006
- 2012
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 40:2, s. 115-125
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To describe and compare health-related quality of life (HRQoL) among homeless persons with a general population sample in Stockholm County, 2006, and to analyse the importance of certain social determinants of health among the homeless. Methods: Face-to-face interviews with 155 homeless persons and a postal survey to a general population sample, mainly based on the same questionnaire, including questions on social determinants of health and HRQoL measured with the EQ-5D. Results: Chronic illness was three times more common among the homeless. HRQoL was worse among homeless persons than in the general population sample: the homeless reported more problems, especially more severe problems, in all the EQ-5D dimensions and had considerably lower EQ-5Dindex and EQVAS score than the general population. Most problems were reported in the dimension anxiety/depression. Among the homeless, longer duration and more severe degree of homelessness lowered HRQoL, but few determinants were statistically significantly related to HRQoL. Having mental disease significantly lowered HRQoL. Conclusions: This study was an attempt to include hard-to-reach groups in an assessment of population health. Homeless persons had considerably worse HRQoL than the general population and reported most problems in the dimension anxiety/depression. Some diseases may contribute to causing homelessness; others may be seen as consequences. Homeless persons are a vulnerable group in society. Further interview studies are needed based on larger sample of homeless persons to explore health determinants such as sex, age, socioeconomic factors, duration and degree of homelessness, and health-related behaviours among the homeless persons.
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| 10. |
- Yngwe, MA, et al.
(författare)
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On the importance of internalized consumption norms for ill health
- 2006
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 34:1, s. 76-82
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Relative deprivation has in previous studies been put forward as a possible mechanism in the income and health relation. To capture the importance of social comparisons analytically has been problematic due to the difficulty in identifying reference groups of significance for the individual. The authors suggest that using the individual's own preferences, arguing these to be preferences of both society and reference groups internalized by the individual, may partly bridge this problem. Methods: The study is based on the Swedish Survey of Living Conditions 1998 including a list of 37 consumption items and activities. By counting the items that the individual cannot afford, but at the same time considers to be a necessity and something that all adults should afford, a measure of self-rated deprivation (SRD) is constructed. The outcome measure used is less than good self-rated health and limiting longstanding illness. Men and women aged 25—64 years are included. Results: Over the different groups of self-rated deprivation a clear gradient in ill health, for both health measures, was found among women. The results for men seemed to dichotomize between non-deprived and those deprived on at least one item. The logistic regression models showed that even after adjusting for socioeconomic group and cash margin, there was a significant effect of self-rated deprivation. Conclusions: A significant relation was found between self-rated deprivation and ill health, both less than good health and limiting longstanding illness. Self-rated deprivation had a stronger impact on women than men.
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