Socioeconomic Disparities in Prehospital Emergency Care in a Danish Tax-Financed Healthcare System: Nationwide Cohort Study

Abstract

Background Differences related to socioeconomic status (SES) in use of prehospital emergency medical services (EMS) have been reported. However, detailed data on potential disparities in the quality of the EMS according to SES are lacking. Methods A nationwide cohort study of medical emergency calls made to the Danish emergency number 1-1-2 in the period 2016–2017. To measure quality of care, performance indicators from the Danish Quality Registry for Prehospital Emergency Medical Services were used. SES was based on income, education and adherence to workforce. Poisson regression was used to measure relative risk (RR). Results We included 388,378 medical 1-1-2 calls, of which 261,771 were unique individuals; 42% of the calls concerned patients with low education, 5% concerned patients living in relative poverty and 23% concerned patients receiving social subsidy. There were no significant differences between the SES regarding time span for arrival of first EMS units. However, patients receiving social subsidy and retired people were more likely to be released at scene and to call again within 24 hours: Adjusted RRs were 2.79 [2.20; 3.54] and 2.08 [1.58; 2.75], respectively, compared with patients having a job. In addition, patients receiving social subsidy and retired people were more likely to call again within 24 hours after receiving telephone advice only: Adjusted RRs 2.35 [1.95; 2.82] and 1.88 [1.51; 2.35], respectively compared with patients having a job. Adjusted RRs for unplanned hospital contact after being treated and released at scene were higher for patients receiving social subsidy and retired people, respectively, relative to patients having a job. Conclusion Patients with low SES were significantly more likely to contact the hospital or EMS again after their first call or after treatment and release at scene compared with patients with high SES. This indicates that callers with low SES did not receive the appropriate help.

Socioeconomic status and outcomes after in-hospital cardiac arrest

“…of advance directives, 24 social support, [25][26] and nursing home 284 utilization. 18,24 In Denmark, studies have indicated that socioeco-285 nomic differences in utilizing and obtaining care may exist, [27][28][29][30][31] 286 which might partly explain our results for survival to one year after 287 IHCA. Moreover, we observed a higher proportion of patients with 288 psychiatric disorders among patients with low SES.…”

“…While socioeconomic inequalities in shortterm outcomes after IHCA may relate to hospital-level treatment (e.g., post-cardiac arrest procedures 21 and the duration of resuscitation), socioeconomic inequalities in long-term outcomes may relate to additional factors that are less related to the initial hospital treatment. These may potentially include differences in adequate healthcare after hospital discharge [22][23] along with the provision 25) 213 ( 20) 1 (0) 20 (13,30) 663 ( 46) 280 ( 19) 214 ( 15) 0 (0) 20 (13,29) 645 ( 50) 324 ( 25) 255 ( 20) 0 (0) 19 (12,28) 244 ( 50) 125 ( 26) 99 ( 20) 1 (0) 20 (13,30) Categorical data is presented as counts with frequencies (%). Continuous data is presented as medians with quartiles (quartile 1, quartile 3).…”

The effect of emergency department history on health literacy level and role of digital literacy: An observational study

“…In addition, individuals using EMSs must use them consciously and have a high level of knowledge. [4,5] At this point, the concept of health literacy, which indicates the ability of individuals to effectively understand and comprehend health information, comes to the fore.…”