Individual and Area-level Factors Contributing to the Geographic Variation in Ambulatory Care Sensitive Conditions in Finland

Satokangas, Markku; Arffman, Martti; Antikainen, Harri; Leyland, Alastair H.; Keskimäki, Ilmo

doi:10.1097/mlr.0000000000001454

Cited by 4 publications

(7 citation statements)

References 40 publications

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“…Most studies on the association between spatial access and ACSC admission are ecological studies at the county level, using data from a wide area, such as the state or national level ( Carneiro, 2018 ; Friedman & Basu, 2001 ; Huang et al, 2019 ). Few studies have focused on the effect of spatial access, the area-level factor, on individuals’ health outcomes ( Satokangas et al, 2021 ). Also, the individual-level attributes that are sensitive to spatial access have not been well clarified.…”

Section: Introductionmentioning

confidence: 99%

Association between spatial access and hospitalization for ambulatory care sensitive conditions: A retrospective cohort study using claims data

Iba,

Tomio,

Sugiyama

et al. 2024

SSM - Population Health

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Section: Introductionmentioning

confidence: 99%

Association between spatial access and hospitalization for ambulatory care sensitive conditions: A retrospective cohort study using claims data

Iba,

Tomio,

Sugiyama

et al. 2024

SSM - Population Health

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“…On the other hand, ACSCs are also impacted by factors that either confound the measurement of PHC performance or are beyond the scope of PHC. Indeed, risk of ACSCs associates strongly with factors related to individual characteristics such as self-rated health [ 18 ], comorbidities [ 18 – 20 ] and SEP [ 18 , 20 , 21 ]. Older age especially predisposes people to ACSCs through the accumulation of comorbid conditions [ 22 ], their increased severity [ 23 ], and limitations in activities of daily living [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…The socioeconomic disparities in ACSCs emerge as an inverse socioeconomic gradient that disfavours the poorest [ 21 , 37 ], with the risk increasing even further due to accumulation and prolongation of different socioeconomic disadvantages over time [ 36 ]. While the geographic disparities in ACSCs can mirror variation in PHC quality [ 32 ], they also mirror the differences for example in inhabitants’ health status and SEP [ 18 , 20 , 33 , 38 ] as well as structural differences related to areas’ hospital supply and arrangement of hospital care [ 20 , 39 ].…”

Section: Introductionmentioning

confidence: 99%

Performing up to Nordic principles? Geographic and socioeconomic equity in ambulatory care sensitive conditions among older adults in capital areas of Denmark, Finland and Sweden in 2000–2015

Satokangas

Arffman

Agerholm

et al. 2023

BMC Health Serv Res

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Background Denmark, Finland and Sweden pursue equity in health for their citizens through universal health care. However, it is unclear if these services reach the older adult population equally across different socioeconomic positions or living areas. Thus, we assessed geographic and socioeconomic equity in primary health care (PHC) performance among the older adults in the capital areas of Denmark (Copenhagen), Finland (Helsinki) and Sweden (Stockholm) in 2000–2015. Hospitalisations for ambulatory care sensitive conditions (ACSC) were applied as a proxy for PHC performance. Methods We acquired individual level ACSCs for those aged ≥ 45 in 2000–2015 from national hospitalisation registers. To identify whether the disparities varied by age, we applied three age groups (those aged 45–64, 65–75 and ≥ 75). Socioeconomic disparities in ACSCs were described with incidence rate ratios (IRR) and annual rates by education, income and living-alone; and then analysed with biennial concentration indices by income. Geographic disparities were described with biennial ACSC rates by small areas and analysed with two-level Poisson multilevel models. These models provided small area estimates of IRRs of ACSCs in 2000 and their slopes for development over time, between which Pearson correlations were calculated within each capital area. Finally, these models were adjusted for income to distinguish between geographic and socioeconomic disparities. Results Copenhagen had the highest IRR of ACSCs among those aged 45–64, and Helsinki among those aged ≥ 75. Over time IRRs decreased among those aged ≥ 45, but only in Helsinki among those aged ≥ 75. All concentration indices slightly favoured the affluent population but in Stockholm were mainly non-significant. Among those aged ≥ 75, Pearson correlations were low in Copenhagen (-0.14; p = 0.424) but high in both Helsinki (-0.74; < 0.001) and Stockholm (-0.62; < 0.001) – with only little change when adjusted for income. Among those aged ≥ 45 the respective correlations were rather similar, except for a strong correlation in Copenhagen (-0.51, 0.001) after income adjustment. Conclusions While socioeconomic disparities in PHC performance persisted among older adults in the three Nordic capital areas, geographic disparities narrowed in both Helsinki and Stockholm but persisted in Copenhagen. Our findings suggest that the Danish PHC incorporated the negative effects of socio-economic segregation to a lesser degree.

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“…In 2018, for example, there were 1,191 A&E attendances per 1000 infants in London (compared to 957 per 1000 infants in England overall) [17], but 261 emergency admissions per 1000 infants in London (compared to 389 per 1000 infants in England overall) [18]. Reasons for such large variations are likely complex and multifactorial, highlighting the importance of considering individual-level maternal and infant risk factors for emergency hospital care [19,20]. Improving our understanding of the drivers of geographical variation in A&E attendances and subsequent emergency hospital admissions for infants is, therefore, a key public health issue [21] and would enable us to determine the extent to which rates are driven by different population needs or other service related factors.…”

Section: Introductionmentioning

confidence: 99%

Determinants of accident and emergency attendances and emergency admissions in infants: birth cohort study

Nath

Zylbersztejn

Viner

et al. 2022

BMC Health Serv Res

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Background There is limited understanding of the drivers of increasing infant accident and emergency (A&E) attendances and emergency hospital admissions across England. We examine variations in use of emergency hospital services among infants by local areas in England and investigate the extent to which infant and socio-economic factors explain these variations. Methods Birth cohort study using linked administrative Hospital Episode Statistics data in England. Singleton live births between 1-April-2012 and 31-March-2019 were followed up for 1 year; from 1-April-2013 (from the discharge date of their birth admission) until their first birthday, death or 31-March-2019. Mixed effects negative binomial models were used to calculate incidence rate ratios for A&E attendances and emergency admissions and mixed effects logistic regression models estimated odds ratio of conversion (the proportion of infants subsequently admitted after attending A&E). Models were adjusted for individual-level factors and included a random effect for local authority (LA). Results The cohort comprised 3,665,414 births in 150 English LAs. Rates of A&E attendances and emergency admissions were highest amongst: infants born < 32 weeks gestation; with presence of congenital anomaly; and to mothers < 20-years-old. Area-level deprivation was positively associated with A&E attendance rates, but not associated with conversion probability. A&E attendance rates were highest in the North East (916 per 1000 child-years, 95%CI: 911 to 921) and London (876 per 1000, 95%CI: 874 to 879), yet London had the lowest emergency admission rates (232 per 1000, 95%CI: 231 to 234) and conversion probability (25% vs 39% in South West). Adjusting for individual-level factors did not significantly affect variability in A&E attendance and emergency admission rates by local authority. Conclusions Drivers of A&E attendances and emergency admissions include individual-level factors such being born premature, with congenital anomaly and from socio-economically disadvantaged young parent families. Support for such vulnerable infants and families should be provided alongside preventative health care in primary and community care settings. The impact of these services requires further investigation. Substantial geographical variations in rates were not explained by individual-level factors. This suggests more detailed understanding of local and underlying service-level factors would provide targets for further research on mechanisms and policy priority.

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Individual and Area-level Factors Contributing to the Geographic Variation in Ambulatory Care Sensitive Conditions in Finland

Abstract: Supplemental Digital Content is available in the text.

Cited by 4 publications

References 40 publications

Association between spatial access and hospitalization for ambulatory care sensitive conditions: A retrospective cohort study using claims data

Association between spatial access and hospitalization for ambulatory care sensitive conditions: A retrospective cohort study using claims data

Performing up to Nordic principles? Geographic and socioeconomic equity in ambulatory care sensitive conditions among older adults in capital areas of Denmark, Finland and Sweden in 2000–2015

Determinants of accident and emergency attendances and emergency admissions in infants: birth cohort study

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