Cumulative social disadvantage and hospitalisations due to ambulatory care-sensitive conditions in Finland in 2011─2013: a register study

OBJECTIVES: To study the interplay between several indicators of social disadvantage and hospitalisations due to ambulatory care-sensitive conditions (ACSC) in 2011─2013. To evaluate whether the accumulation of preceding social disadvantage in one point of time or prolongation of social disadvantage had an effect on hospitalisations due to ACSCs. Four common indicators of disadvantage are examined: living alone, low level of education, poverty and unemployment. DESIGN: A population-based register study. SETTING: Nationwide individual-level register data on hospitalisations due to ACSCs for the years 2011–2013 and preceding data on social and socioeconomic factors for the years 2006─2010. PARTICIPANTS: Finnish residents aged 45 or older on 1 January 2011. OUTCOME MEASURE: Hospitalisations due to ACSCs in 2011–2013. The effect of accumulation of preceding disadvantage in one point of time and its prolongation on ACSCs was studied using modified Poisson regression. RESULTS: People with preceding cumulative social disadvantage were more likely to be hospitalised due to ACSCs. The most hazardous combination was simultaneously living alone, low level of education and poverty among the middle-aged individuals (aged 45–64 years) and the elderly (over 64 years). Risk ratio (RR) of being hospitalised due to ACSC was 3.16 (95% CI 3.03–3.29) among middle-aged men and 3.54 (3.36–3.73) among middle-aged women compared with individuals without any of these risk factors when controlling for age and residential area. For the elderly, the RR was 1.61 (1.57–1.66) among men and 1.69 (1.64–1.74) among women. CONCLUSIONS: To improve social equity in healthcare, it is important to recognise not only patients with cumulative disadvantage but also—as this study shows—patients with particular combinations of disadvantage who may be more susceptible. The identification of these vulnerable patient groups is also necessary to reduce the use of more expensive treatment in specialised healthcare.