Research ArticleResearch Brief

Relationships of Multimorbidity and Income With Hospital Admissions in 3 Health Care Systems

Harry H. X. Wang, Jia Ji Wang, Kenny D. Lawson, Samuel Y. S. Wong, Martin C. S. Wong, Fang Jian Li, Pei Xi Wang, Zhi Heng Zhou, Chun Yan Zhu, Yao Qun Yeong, Sian M. Griffiths and Stewart W. Mercer
The Annals of Family Medicine March 2015, 13 (2) 164-167; DOI: https://doi.org/10.1370/afm.1757

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  • Table 1

    Logistic Regression Models for Hospital Admissions in the Past 12 Months Among Patients Aged ≥20 Years

    CovariateScotland (n = 26,895) China (n = 124,829) Hong Kong (n = 23,839)
    cOR (95% CI)aaORb (95% CI)acOR (95% CI)aaORb (95% CI)acOR (95% CI)aaORb (95% CI)a
    Sex, male0.70 (0.65–0.76)0.75 (0.69–0.81)0.80 (0.79–0.81)0.75 (0.73–0.76)0.81 (0.74–0.89)0.79 (0.70–0.89)
    Age, per 5 years1.06 (1.05–1.07)1.02c (1.00–1.04)1.16 (1.16–1.17)1.01d (1.00–1.01)1.19 (1.17–1.21)1.06 (1.04–1.08)
    Household income per heade
     Grade 41.00 (Ref)1.00 (Ref)1.00 (Ref)1.00 (Ref)1.00 (Ref)1.00 (Ref)f
     Grade 31.32 (1.14–1.53)1.23 (1.06–1.43)0.85 (0.83–0.87)0.74 (0.72–0.76)0.81 (0.69–0.95)0.83 (0.71–0.97)
     Grade 21.90 (1.67–2.15)1.56 (1.37–1.77)0.80 (0.79–0.82)0.67 (0.66–0.69)1.23 (1.06–1.44)0.90 (0.77–1.06)
     Grade 12.28 (2.01–2.59)1.62 (1.41–1.86)0.68 (0.67–0.70)0.58 (0.56–0.60)1.91 (1.65–2.21)0.89 (0.75–1.06)
    Education level
     No qualifications1.00 (Ref)1.00 (Ref)1.00 (Ref)1.00 (Ref)1.00 (Ref)1.00 (Ref)
     Other0.65 (0.60–0.71)0.94g (0.86–1.04)0.68 (0.67–0.69)1.47 (1.43–1.52)0.39 (0.34–0.44)0.83h (0.72–0.96)
    Employment status
     Unemployed1.00 (Ref)1.00 (Ref)1.00 (Ref)1.00 (Ref)1.00 (Ref)1.00 (Ref)
     Other0.50 (0.46–0.55)0.69 (0.62–0.77)0.58 (0.57–0.60)0.70 (0.68–0.72)0.77 (0.69–0.87)0.83i (0.73–0.94)
    Tobacco, smoker1.23 (1.14–1.34)1.16 (1.06–1.27)2.20 (2.16–2.24)1.26 (1.25–1.27)1.33 (1.19–1.50)1.37 (1.20–1.57)
    Numbers of chronic conditions in ICD-10 coding categories
    01.00 (Ref)1.00 (Ref)1.00 (Ref)1.00 (Ref)1.00 (Ref)1.00 (Ref)
     11.80 (1.62–2.01)1.77 (1.59–1.98)4.82 (4.60–5.06)4.89 (4.63–5.15)3.09 (2.74–3.48)2.63 (2.31–2.98)
     22.56 (2.28–2.88)2.41 (2.12–2.72)5.58 (5.31–5.87)5.53 (5.25–5.82)4.80 (4.17–5.53)3.69 (3.16–4.31)
     33.96 (3.48–4.51)3.53 (3.06–4.07)8.45 (8.19–8.71)8.18 (7.89–8.47)6.91 (5.73–8.32)4.96 (4.05–6.08)
     ≥45.19 (4.40–6.12)4.33 (3.63–5.17)21.04 (20.05–22.08)20.36 (19.34–21.43)9.78 (7.68–12.46)7.02 (5.43–9.06)

    Notes: Dependent variable was admission to a hospital (secondary level or above) with at least 1 overnight stay in the 12 months before the survey.

    • aOR = adjusted odds ratio; cOR = crude odds ratio; ICD-10 = International Classification of Diseases,10th Edition; Ref = reference group.

    • ↵a P values are based on joint tests, which test the overall differences between the individual categories of the corresponding variable. All are <.001 unless otherwise noted.

    • ↵b Adjusted for all other covariates (independent variables) listed in the table.

    • ↵c P = .02.

    • ↵d P = .005.

    • ↵e Grade 1 refers to as having less than one-half of the average income level; grade 2 refers to having more than that but less than the average level; grade 3 refers to having an income between the average and twice the average; grade 4 refers to having more than twice the average income level.

    • ↵f P = .16.

    • g P = .24.

    • ↵h P = .01.

    • ↵i P = .004.

Additional Files

  • The Article in Brief

    Relationships of Multimorbidity and Income With Hospital Admissions in 3 Health Care Systems

    Stewart W. Mercer , and colleagues

    Background This study looks at the relationships between income, hospital admissions, and multimorbidity (having two or more chronic conditions) in three countries with differing health care systems: Scotland, where a public healthcare system provides universal coverage; China, which does not provide universal health coverage and patients usually pay out-of-pocket; and Hong Kong, which has a dual-track system of both public and private health care.

    What This Study Found Higher levels of multimorbidity are related to higher hospital admissions in all three settings. In Scotland, poorer patients have more hospital admissions, while China shows the opposite: those with lower incomes have lower odds of hospitalization. In Hong Kong, poorer people are more likely to be admitted to public hospitals, but less likely to be admitted to private ones.

    Implications

    • These findings offer insights into how health care systems might be made more equitable and effective.
    • Strategies to improve equitable health care should consider the impact of socioeconomic status on the use of health care resources, particularly among populations with high rates of multimorbidity.
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