Contribution of hospital mortality variations to socioeconomic disparities in in-hospital mortality

被引:14
作者
Kim, Yoon [1 ,2 ]
Oh, Juhwan [1 ]
Jha, Ashish [3 ]
机构
[1] Seoul Natl Univ, Coll Med, Dept Hlth Policy & Management, Seoul, South Korea
[2] Seoul Natl Univ, Med Res Ctr, Inst Hlth Policy & Management, Seoul, South Korea
[3] Harvard Univ, Dept Hlth Policy & Management, Boston, MA 02115 USA
关键词
ACUTE MYOCARDIAL-INFARCTION; SURGICAL MORTALITY; HEALTH-CARE; RACE;
D O I
10.1136/bmjqs-2013-002744
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background While disparities in hospital care outcomes based on ethnicity or socioeconomic status have been documented in some nations, it is unclear to what extent this phenomenon occurs in high-income countries like Korea with relatively low income inequality. Methods We examined in-hospital mortality rates for wealthy and poor patients in South Korea for five common medical conditions. We measured in-hospital mortality rates and examined within-hospital differences (wealthy and poor patients receive different care at the same institution) as well as between-hospital differences (wealthy and poor patients receiving care at different institutions) across socioeconomic status. We built multivariable models that adjusted for risk and further adjusted our analyses for hospital characteristics including a hospital's overall mortality ranking. Results There were 127 438 patients with one of the five conditions examined nested in 66 Korean hospitals. We found moderate differences in mortality rates between wealthy and poor patients across four of the five conditions. These mortality differences were largely attributable to differences in mortality rates for wealthy patients compared with those for poor patients within the same hospital (within-hospital variation) while a relatively small portion of these disparities were attributable to mortality difference between hospitals where wealthy and poor patients seek care (between-hospital variation). For example, we estimate that improving care for poor patients in the same hospital can eliminate 86% of the disparities for acute myocardial infarction outcomes, while ensuring equal access to low mortality hospitals would reduce only 16% of the disparities in outcomes. Conclusions This study suggests that to reduce socioeconomic disparities in hospital mortality, interventions that target within-hospital effects may be more effective than interventions targeting between hospital effects.
引用
收藏
页码:741 / 748
页数:8
相关论文
共 23 条
  • [1] The association of socioeconomic disadvantage with postoperative complications after major elective cardiovascular surgery
    Agabiti, N.
    Cesaroni, G.
    Picciotto, S.
    Bisanti, L.
    Caranci, N.
    Costa, G.
    Forastiere, F.
    Marinacci, C.
    Pandolfi, P.
    Russo, A.
    Perucci, C. A.
    [J]. JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 2008, 62 (10) : 882 - 889
  • [2] Agency for Healthcare Research and Quality (AHRQ), 2009, INP QUAL IND OV
  • [3] Geographical Distribution of Surgical Capabilities and Disparities in the Use of High-Volume Providers The Case of Coronary Artery Bypass Graft
    Bao, Yuhua
    Kamble, Shital
    [J]. MEDICAL CARE, 2009, 47 (07) : 794 - 802
  • [4] Patient Socioeconomic Status Is an Independent Predictor of Operative Mortality
    Bennett, Kyla M.
    Scarborough, John E.
    Pappas, Theodore N.
    Kepler, Thomas B.
    [J]. ANNALS OF SURGERY, 2010, 252 (03) : 552 - 558
  • [5] Socioeconomic status and surgical mortality in the elderly
    Birkmeyer, Nancy J. O.
    Gu, Niya
    Baser, Onur
    Morris, Arden M.
    Birkmeyer, John D.
    [J]. MEDICAL CARE, 2008, 46 (09) : 893 - 899
  • [6] Hospital Factors and Racial Disparities in Mortality After Surgery for Breast and Colon Cancer
    Breslin, Tara M.
    Morris, Arden M.
    Gu, Niya
    Wong, Sandra L.
    Finlayson, Emily V.
    Banerjee, Mousumi
    Birkmeyer, John D.
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 2009, 27 (24) : 3945 - 3950
  • [7] Curry Jr WT, 2010, NEUROSURGERY, V66, P37
  • [8] Racial, Ethnic, and Socioeconomic Disparities in Patient Outcomes After Craniotomy for Tumor in Adult Patients in the United States, 1988-2004
    Curry, William T., Jr.
    Carter, Bob S.
    Barker, Fred G., II
    [J]. NEUROSURGERY, 2010, 66 (03) : 427 - 437
  • [9] Racial and Ethnic Differences in the Use of High-Volume Hospitals and Surgeons
    Epstein, Andrew J.
    Gray, Bradford H.
    Schlesinger, Mark
    [J]. ARCHIVES OF SURGERY, 2010, 145 (02) : 179 - 186
  • [10] Role of socioeconomic status in kidney transplant outcome
    Goldfarb-Rumyantzev, Alexander S.
    Koford, James K.
    Baird, Bradley C.
    Chelamcharla, Madhukar
    Habib, Arsalan N.
    Wang, Ben-Jr
    Lin, Shih-Jui
    Shihab, Fuad
    Isaacs, Ross B.
    [J]. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2006, 1 (02): : 313 - 322