Socioeconomic variation in the burden of chronic conditions and health care provision - analyzing administrative individual level data from the Basque Country, Spain
Socioeconomic variation in the burden of chronic conditions and health care provision - analyzing administrative individual level data from the Basque Country, Spain
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DOI：
10.1186/1471-2458-13-870
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发表时间：
2013-09-22
影响因子：
4.5
通讯作者：
Nuno-Solinis, Roberto
中科院分区：
文献类型：
--
作者：
Orueta, Juan F.;Garcia-Alvarez, Arturo;Nuno-Solinis, Roberto
背景资料：慢性病对社会构成越来越大的挑战，相关负担沉重地落在更多贫困的个人和地区身上。虽然存在社会经济健康梯度是世界各地卫生政策的主要关切之一，但卫生信息系统通常没有可靠的数据来发现和监测卫生不平等和不公平现象。本研究的目的是测量慢性病患病率中与社会经济相关的不平等水平，并调查卫生保健提供中不平等的程度和方向。方法：一个数据集，将居住在巴斯克地区的整个人口的临床和行政信息联系起来，西班牙（超过200万人）被用来衡量52种慢性病的患病率，并量化个人医疗保健费用。我们使用了浓度指数的方法来衡量的程度和方向的不平等，就剥夺了居住区的每个individual.Results：大多数慢性病被发现是过度集中在个人生活在更贫困的地区，但不平衡的程度因疾病类型和性别而异。卫生保健利用率的变化大部分是由发病率负担解释的。然而，即使考虑到发病率的差异，在专科门诊、急诊、处方和初级卫生保健费用方面也存在扶贫横向不平等，这一事实在女性中比男性更明显;住院费用在两性中的分布是公平的。对个人层面的综合管理临床信息进行分析，可以使慢性病和卫生保健提供的社会经济梯度，使用其他来源无法测量到的详细程度。这一经常更新的信息来源可用于监测趋势和评价政策改革的影响。
Background: Chronic diseases are posing an increasing challenge to society, with the associated burden falling disproportionally on more deprived individuals and geographical areas. Although the existence of a socioeconomic health gradient is one of the main concerns of health policy across the world, health information systems commonly do not have reliable data to detect and monitor health inequalities and inequities. The objectives of this study were to measure the level of socioeconomic-related inequality in prevalence of chronic diseases and to investigate the extent and direction of inequities in health care provision.Methods: A dataset linking clinical and administrative information of the entire population living in the Basque Country, Spain (over 2 million individuals) was used to measure the prevalence of 52 chronic conditions and to quantify individual health care costs. We used a concentration-index approach to measure the extent and direction of inequality with respect to the deprivation of the area of residence of each individual.Results: Most chronic diseases were found to be disproportionally concentrated among individuals living in more deprived areas, but the extent of the imbalance varies by type of disease and sex. Most of the variation in health care utilization was explained by morbidity burden. However, even after accounting for differences in morbidity, pro-poor horizontal inequity was present in specialized outpatient care, emergency department, prescription, and primary health care costs and this fact was more apparent in females than males; inpatient costs exhibited an equitable distribution in both sexes.Conclusions: Analyses of comprehensive administrative clinical information at the individual level allow the socioeconomic gradient in chronic diseases and health care provision to be measured to a level of detail not possible using other sources. This frequently updated source of information can be exploited to monitor trends and evaluate the impact of policy reforms.