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Income disparities in healthcare use remain after controlling for healthcare need : evidence from Swedish register data on psoriasis and psoriatic arthritis

Löfvendahl, Sofia LU ; Jöud, Anna LU ; Petersson, Ingemar F. LU ; Theander, Elke LU ; Svensson, Åke LU and Carlsson, Katarina Steen LU (2017) In European Journal of Health Economics p.1-16
Abstract

We used a southern Swedish cohort of psoriasis (PSO) and psoriatic arthritis (PsA) patients and population-based referents (N = 57,800) to investigate the influence of socioeconomic and demographic factors on the probability of healthcare use and on healthcare costs when controlling for need as measured by PSO/PsA and common additional morbidities such as diabetes, depression and myocardial infarction. People with PSO/PsA were identified by ICD-10 codes in the Skåne Healthcare Register 1998–2007. Resource use and costs for years 2008–2011 were retrieved from the Skåne Healthcare Register and the Swedish Prescribed Drug Register, and socioeconomic data were retrieved from Statistics Sweden. After controlling for PSO/PsA and common... (More)

We used a southern Swedish cohort of psoriasis (PSO) and psoriatic arthritis (PsA) patients and population-based referents (N = 57,800) to investigate the influence of socioeconomic and demographic factors on the probability of healthcare use and on healthcare costs when controlling for need as measured by PSO/PsA and common additional morbidities such as diabetes, depression and myocardial infarction. People with PSO/PsA were identified by ICD-10 codes in the Skåne Healthcare Register 1998–2007. Resource use and costs for years 2008–2011 were retrieved from the Skåne Healthcare Register and the Swedish Prescribed Drug Register, and socioeconomic data were retrieved from Statistics Sweden. After controlling for PSO/PsA and common additional morbidities, income, and to some extent education, had significant effects on the probability of five types of healthcare use. Overall, income showed a bell-shaped relationship to healthcare costs, with patients in income quintiles 2 and 3 having the highest mean annualized cost irrespective of model specification. Education did not have a significant effect in most specifications. Analyses including interaction effects indicated similarly higher costs across income quintiles in the PSO and PsA subgroups, though these cost differences were lower in magnitude for patients with PSO in quintile 5 and with PsA in quintile 1. In conclusion, our results show persistent socioeconomic disparities in healthcare use among a cohort of chronically ill patients and referents, even after controlling for the presence of PSO/PsA and common additional morbidities. These disparities persist even in a country with general healthcare coverage and low out-of-pocket payments.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Disparities, Healthcare use, Psoriasis, Psoriatic arthritis, Socioeconomic factors
in
European Journal of Health Economics
pages
16 pages
publisher
Springer
external identifiers
  • scopus:85019631505
ISSN
1618-7598
DOI
10.1007/s10198-017-0895-5
language
English
LU publication?
yes
id
166b4a2a-5a52-42b2-9a7c-46b1cc751a08
date added to LUP
2017-06-30 14:34:22
date last changed
2018-01-07 12:10:06
@article{166b4a2a-5a52-42b2-9a7c-46b1cc751a08,
  abstract     = {<p>We used a southern Swedish cohort of psoriasis (PSO) and psoriatic arthritis (PsA) patients and population-based referents (N = 57,800) to investigate the influence of socioeconomic and demographic factors on the probability of healthcare use and on healthcare costs when controlling for need as measured by PSO/PsA and common additional morbidities such as diabetes, depression and myocardial infarction. People with PSO/PsA were identified by ICD-10 codes in the Skåne Healthcare Register 1998–2007. Resource use and costs for years 2008–2011 were retrieved from the Skåne Healthcare Register and the Swedish Prescribed Drug Register, and socioeconomic data were retrieved from Statistics Sweden. After controlling for PSO/PsA and common additional morbidities, income, and to some extent education, had significant effects on the probability of five types of healthcare use. Overall, income showed a bell-shaped relationship to healthcare costs, with patients in income quintiles 2 and 3 having the highest mean annualized cost irrespective of model specification. Education did not have a significant effect in most specifications. Analyses including interaction effects indicated similarly higher costs across income quintiles in the PSO and PsA subgroups, though these cost differences were lower in magnitude for patients with PSO in quintile 5 and with PsA in quintile 1. In conclusion, our results show persistent socioeconomic disparities in healthcare use among a cohort of chronically ill patients and referents, even after controlling for the presence of PSO/PsA and common additional morbidities. These disparities persist even in a country with general healthcare coverage and low out-of-pocket payments.</p>},
  author       = {Löfvendahl, Sofia and Jöud, Anna and Petersson, Ingemar F. and Theander, Elke and Svensson, Åke and Carlsson, Katarina Steen},
  issn         = {1618-7598},
  keyword      = {Disparities,Healthcare use,Psoriasis,Psoriatic arthritis,Socioeconomic factors},
  language     = {eng},
  month        = {05},
  pages        = {1--16},
  publisher    = {Springer},
  series       = {European Journal of Health Economics},
  title        = {Income disparities in healthcare use remain after controlling for healthcare need : evidence from Swedish register data on psoriasis and psoriatic arthritis},
  url          = {http://dx.doi.org/10.1007/s10198-017-0895-5},
  year         = {2017},
}