scholarly journals The inpatient, outpatient and social care costs associated with atrial fibrillation in Scotland: a record linkage study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Giorgio Ciminata ◽  
Olivia Wu ◽  
Claudia Geue
Keyword(s):  
Economic Burden ◽  
Social Care ◽  
Hospital Admissions ◽  
Healthcare Resource ◽  
Economic Status ◽  
Care Home ◽  
Individual Level ◽  
Socio Economic Status ◽  
The Cost ◽  
Care Costs

ABSTRACTBackgroundAtrial Fibrillation (AF) is a highly debilitating condition with significant economic burden. Previous studies have estimated the cost of hospitalisations associated with AF in Scotland. However, patients with AF are often elderly with co-morbidities requiring substantial outpatient and social care. ObjectivesThis study seeks to estimate inpatient, outpatient and social care costs associated with AF in a Scottish cohort, by using individual-level linked data. MethodsThe AF cohort of 50 years and older patients, hospitalised with a known diagnosis of AF or atrial flutter between 1997 and 2014, was followed up for five years following the first AF event. Individual-level data on hospitalisation and discharge to social care home were obtained from the Scottish Morbidity Records (SMR01); whereas data on outpatient attendance were obtained from (SMR00). Death records for the same time period were extracted from National Records of Scotland (NRS). Hospital and outpatient costs associated with the corresponding data were estimated utilising the Scottish National Tariff (SNT) based on Healthcare Resource Groups (HRGs), and the Scottish Health Service Costs report, respectively. Social care costs were identified from the Care Home Census. Following data linkage, the econometric analysis was carried out using a two-part model where, the first part estimates through a probit model the probability of using a healthcare service, and the second part estimates costs conditional on having incurred positive costs. The regression model was adjusted for demographic characteristics, socio-economic status, year of admission and location. ResultsOverall, a cohort of 253,963 AF patients accounted for 2,988,607 hospital admissions and 4,452,476 outpatient attendances. The mean cost per patient was estimated to be £3,071 (95% CI 3,033-3,109). Overall, hospital admissions and outpatient visits accounted for 71.7% and 3.7% of the total cost, respectively; social care accounted for 24.6% of the total costs. The cost increased with age and females incurred higher costs than males. Significant differences were observed among the urban/rural classifications, individual health boards and the socio-economic status. ConclusionsThis study has shown the importance of taking into account healthcare resource use incurred beyond hospitalisation. In addition to inpatient costs, outpatient and social care costs contribute considerably to the overall economic burden.

scholarly journals COVID-19 risk factors amongst 14,786 care home residents: An observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays, and vaccination status in Wales (UK) between 1st September 2020 and 1st May 2021.

2021 ◽  
Author(s):  
Joe Hollinghurst ◽  
Robyn Hollinghurst ◽  
Laura North ◽  
Amy Mizen ◽  
Ashley Akbari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Hospital Admissions ◽  
Care Home ◽  
Vaccination Status ◽  
Care Homes ◽  
Positive Test ◽  
Care Providers ◽  
Specialist Care ◽  
Individual Level

Objectives: Determine individual level risk factors for care home residents testing positive for SARS-CoV-2. Study Design: Longitudinal observational cohort study using individual-level linked data. Setting: Care home residents in Wales (United Kingdom) between 1st September 2020 and 1st May 2021. Participants: 14,786 older care home residents (aged 65+). Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes. Methods: We estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 polymerase chain reaction (PCR) test. We included time dependent covariates for the estimated community positive test rate of COVID-19, hospital admissions, and vaccination status. Additional covariates were included for age, positive PCR tests prior to the study, sex, frailty (using the hospital frailty risk score), and specialist care home services. Results: The multivariable logistic regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year of age), community positive test rate (OR 1.13 [1.12,1.13] per percent increase in positive test rate), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09] respectively) were associated with a decreased odds of a positive test. Conclusions: Our findings suggest care providers need to stay vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Furthermore, minimising potential COVID-19 infection for care home residents admitted to hospital should be prioritised.

scholarly journals Area and individual circumstances and mood disorder prevalence

2004 ◽  
Vol 185 (3) ◽  
pp. 227-232 ◽  
Author(s):  
Nicholas W. J. Wainwright ◽  
Paul G. Surtees
Keyword(s):  
Health Outcomes ◽  
Mood Disorder ◽  
Mood Disorders ◽  
Economic Status ◽  
Relative Strength ◽  
Area Deprivation ◽  
Cross Sectional ◽  
Individual Level ◽  
Socio Economic Status ◽  
The Individual

BackgroundAssociations have been demonstrated between contextual (area level) factors and a range of physical health outcomes, but their relationship with mental health outcomes is less well understood.AimsTo investigate the relative strength of association between individual and area-level demographic and socioeconomic factors and mood disorder prevalence in the UK.MethodCross-sectional data from 19 687 participants from the European Prospective Investigation into Cancer and Nutrition in Norfolk.ResultsArea deprivation was associated with current (12-month) mood disorders after adjusting for individual-level socio-economic status (OR for top v. bottom quartile of deprivation scores 1.29, 95% C11.1–1.5, P < 0.001). However, this association was small relative to those observed for individual marital and employment status. Significant residual area-level variation in current mood disorders (representing 3.6% of total variation, P=0.04) was largely accounted for by individual-level factors.ConclusionsThe magnitude of the association between socio-economic status and mood disorders is greater at the individual level than at the area level.

Health status in adolescents: which relation with family image?

1997 ◽  
Vol 6 (1) ◽  
pp. 59-68 ◽  
Author(s):  
Simona Villani ◽  
Mario Grassi ◽  
Alessandra Marinoni ◽  
Gruppo Di Lavoro Adolescenti
Keyword(s):  
Hospital Admissions ◽  
Economic Status ◽  
Cross Sectional Study ◽  
Family Characteristics ◽  
Canonical Variate ◽  
Cross Sectional ◽  
Socio Economic Status ◽  
Physical Distress ◽  
Life Circumstances ◽  
The Relationship

SUMMARYIntroduction — Many studies have been carried out recently to investigate the relationship between health conditions and family and self characteristics. Objectives — To identify family characteristics (such as type of family, socio-economic status, parent immigration, affection for parents, parents' psychological and physical health) and self characteristics (age, drug use, satisfaction for several life circumstances, psychosomatic symptomatology) that are differently distributed by sex and levels of psychological and physical distress among teen-agers. Methods — We carried out a cross-sectional study on a sample of teen-agers attending high schools in Pavia (Italy), using a self-administered questionnaire. The students were divided in four groups having different levels of psychological and physical distress, based on GHQ-30 (psychological distress indicator), on the number of hospital admissions and consultations to a physician in the last year (the last two are physical distress indicator). Data were analysed applying the multivariate analisy of Canonical Variate. Results — 1346 students were sampled, but only 1189 questionnaire were analysed: 36.8% regarding males and 63.2% females. The Canonical Variate analysis indicated that psycosomatic symptomatology, satisfaction for several life circumstances and affection for parents are important for describing the four distress groups. Conclusions — Only affection for parents has an important role on psychological and physical distress of adolescents, while family characteristics traditionally considered associated with psychological and physical distress in teen-agers (such as living with one or without parents, low socio-economic status) are not associated.

Socio-economic inequalities in mortality persist into old age in New Zealand: study of all 65 years plus, 2001–04

2013 ◽  
Vol 34 (6) ◽  
pp. 911-929 ◽  
Author(s):  
SANTOSH JATRANA ◽  
TONY BLAKELY
Keyword(s):  
New Zealand ◽  
Old Age ◽  
Economic Status ◽  
Adult Mortality ◽  
Housing Tenure ◽  
Mortality Data ◽  
Individual Level ◽  
Socio Economic Status ◽  
Relative Risks ◽  
Rate Ratios

ABSTRACTA number of studies have explored the relationship between socio-economic status and mortality, although these have mostly been based on the working-age population, despite the fact that the burden of mortality is highest in older people. Using Poisson regression on linked New Zealand census and mortality data (2001–04, 1.3 million person years) with a comprehensive set of socio-economic indicators (education, income, car access, housing tenure, neighourhood deprivation), we examined the association of socio-economic characteristics and older adult mortality (65+ years) in New Zealand. We found that socio-economic mortality gradients persist into old age. Substantial relative risks of mortality were observed for all socio-economic factors, except housing tenure. Most relative risk associations decreased in strength with ageing [e.g. most deprived compared to least deprived rate ratio for males reducing from 1.40 (95% confidence interval (CI) 1.28–1.53) for 65–74-year-olds to 1.13 (CI 1.00–1.28) for 85 + -year-olds], except for income and education among women where the rate ratios changed little with increasing age. This suggests individual-level measures of socio-economic status are more closely related to mortality in older women than older men. Comparing across genders, the only statistically significantly different association between men and women was for a weaker association for women for car access.

The cost of being transgender: where socio-economic status, global health care systems, and gender identity intersect

2019 ◽  
Vol 11 (1-2) ◽  
pp. 103-119 ◽  
Author(s):  
Julie M. Koch ◽  
Chris/tine McLachlan ◽  
Cornelius J. Victor ◽  
Jess Westcott ◽  
Christina Yager
Keyword(s):  
Health Care ◽  
Global Health ◽  
Gender Identity ◽  
Economic Status ◽  
Health Care Systems ◽  
Socio Economic Status ◽  
Care Systems ◽  
Global Health Care ◽  
And Gender ◽  
The Cost

scholarly journals Study protocol for investigating the impact of community home modification services on hospital utilisation for fall injuries: a controlled longitudinal study using data linkage

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e026290 ◽  
Author(s):  
Joe Hollinghurst ◽  
Ashley Akbari ◽  
Richard Fry ◽  
Alan Watkins ◽  
Damon Berridge ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Linked Data ◽  
Social Care ◽  
Hospital Admissions ◽  
Care Home ◽  
Frailty Index ◽  
Healthy Ageing ◽  
National Database ◽  
Health And Social Care ◽  
The Impact

IntroductionThis study will evaluate the effectiveness of home adaptations, both in preventing hospital admissions due to falls for older people, and improving timely discharge. Results will provide evidence for services at the interface between health and social care, informing policies seeking to promote healthy ageing through prudent healthcare and fall prevention.Methods and analysisAll individuals living in Wales, UK, aged 60 years and over, will be included in the study using anonymised linked data from the Secure Anonymised Information Linkage Databank. We will use a national database of home modifications implemented by the charity organisation Care & Repair Cymru (C&R) from 2009 to 2017 to define an intervention cohort. We will use the electronic Frailty Index to assign individual levels of frailty (fit, mild, moderate or severe) and use these to create a comparator group (non-C&R) of people who have not received a C&R intervention. Coprimary outcomes will be quarterly numbers of emergency hospital admissions attributed to falls at home, and the associated length of stay. Secondary outcomes include the time in moving to a care home following a fall, and the indicative financial costs of care for individuals who had a fall. We will use appropriate multilevel generalised linear models to analyse the number of hospital admissions related to falls. We will use Cox proportional hazard models to compare the length of stay for fall-related hospital admissions and the time in moving to a care home between the C&R and non-C&R cohorts. We will assess the impact per frailty group, correct for population migration and adjust for confounding variables. Indicative costs will be calculated using financial codes for individual-level hospital stays. Results will provide evidence for services at the interface between health and social care, informing policies seeking to promote healthy ageing through prudent healthcare and prevention.Ethics and disseminationInformation governance requirements for the use of record-linked data have been approved and only anonymised data will be used in our analysis. Our results will be submitted for publication in peer-reviewed journals. We will also work with lay members and the knowledge transfer team at Swansea University to create communication and dissemination materials on key findings.

scholarly journals Classification tree model of the personal economic burden of dementia care by related factors of both people with dementia and caregivers in Japan: a cross-sectional online survey

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026733 ◽  
Author(s):  
Takayo Nakabe ◽  
Noriko Sasaki ◽  
Hironori Uematsu ◽  
Susumu Kunisawa ◽  
Anders Wimo ◽  
...  
Keyword(s):  
Informal Care ◽  
Economic Burden ◽  
Online Survey ◽  
Economic Status ◽  
Dementia Care ◽  
Cross Sectional ◽  
People With Dementia ◽  
Out Of Pocket Payments ◽  
Informal Care Costs ◽  
Care Costs

ObjectiveThe purpose of this study was to clarify the microlevel determinants of the economic burden of dementia care at home in Japanese community settings by classifying them into subgroups of factors related to people with dementia and their caregivers.DesignA cross-sectional online survey.Participants4313 panels of Japanese research company who fulfilled the following criteria: (1) aged 30 years or older, (2) non-professional caregiver of someone with dementia, (3) caring for only one person with dementia and (4) having no conflicts of interest with advertising or marketing research entities.Primary outcome measuresInformal care costs and out-of-pocket payments for long-term care (LTC) services.ResultsFrom 4313 respondents, only 1383 caregivers in community-settings were included in this analysis. We conducted a χ² automatic interaction detection analysis to identify the factors related to each cost (informal care costs and out-of-pocket payments for LTC services) divided into subcategories. In the resultant classifications, informal care cost was mainly related to caregivers’ employment status. When caregivers acquired family care leave, informal care costs were the highest. On the other hand, out-of-pocket payments for LTC were related to care-need levels and family economic status. Activities of Daily Living and Instrumental Activities of Daily Living functions such as bathing, toileting and cleaning were related to all costs.ConclusionThis study clarified the difference in dementia care costs between classified subgroups by considering the combination of the situations of both people with dementia and their caregivers. Informal care costs were related to caregivers’ employment and cohabitation status rather to the situations of people with dementia. On the other hand, out-of-pocket payments for LTC services were related to care-need levels and family economic status. These classifications will be useful in understanding which situation represents a greater economic burden and helpful in improving the sustainability of the dementia care system in Japan.

The cost of falls

2014 ◽  
Vol 22 (4) ◽  
pp. 165-173 ◽  
Author(s):  
Yang Tian ◽  
James Thompson ◽  
David Buck
Keyword(s):  
Community Health ◽  
Social Care ◽  
Community Care ◽  
Care Pathway ◽  
Acute Hospital ◽  
Content Type ◽  
Care Services ◽  
Cent Increase ◽  
The Cost ◽  
Care Costs

Purpose – The purpose of this paper is to explore the whole system cost of the care pathway for older people (aged 65-years old and over) admitted to hospitals as a result of falls in Torbay, a community of 131,000 in the southwest of England with a high proportion of older residents, over a two-year period. Design/methodology/approach – The paper analysed patient-level linked acute hospital, community care and local authority-funded social care data to track patients’ care costs – for those patients admitted to an acute hospital due to their fall – in the 12 months before and after their fall. Findings – On average, the cost of hospital, community and social care services for each admitted for a fall were almost four times as much in the 12 months after admission, than the cost of the admission itself. Over the 12 months that followed admission for falls, costs were 70 per cent higher than in the 12 months before the fall. The most dramatic increase was in community health care costs (160 per cent), compared to a 37 per cent increase in social care costs and a 35 per cent increase in acute hospital care costs. For patients who had a minor fall and those who survived 12 months after the fall, the costs of care home services increased significantly; for patients with hip fracture, the costs of community care services increased significantly; for patients who did not survive 12 months after the fall, the cost of acute inpatient and community health visits increased significantly. Originality/value – This is the only study that has assessed the costs across the acute hospital, community care and social care pathway for this group of patients, in an English population. This will help commissioners and providers understand and develop better-integrated responses to frail elderly patients needs.

scholarly journals A multilevel study of area socio-economic status and food purchasing behaviour

2009 ◽  
Vol 12 (11) ◽  
pp. 2074-2083 ◽  
Author(s):  
Gavin Turrell ◽  
Rebecca Bentley ◽  
Lyndal R Thomas ◽  
Damien Jolley ◽  
SV Subramanian ◽  
...  
Keyword(s):  
Economic Status ◽  
Mail Survey ◽  
Household Composition ◽  
Multilevel Regression ◽  
Food Purchasing ◽  
Small Areas ◽  
Individual Level ◽  
Socio Economic Status ◽  
Dietary Guideline ◽  
Purchasing Behaviour

AbstractObjectiveThe present study examined the association between area socio-economic status (SES) and food purchasing behaviour.DesignData were collected by mail survey (64·2 % response rate). Area SES was indicated by the proportion of households in each area earning less than $AUS 400 per week, and individual-level socio-economic position was measured using education, occupation and household income. Food purchasing was measured on the basis of compliance with dietary guideline recommendations (for grocery foods) and variety of fruit and vegetable purchase. Multilevel regression analysis examined the association between area SES and food purchase after adjustment for individual-level demographic (age, sex, household composition) and socio-economic factors.SettingMelbourne city, Australia, 2003.SubjectsResidents of 2564 households located in fifty small areas.ResultsResidents of low-SES areas were significantly less likely than their counterparts in advantaged areas to purchase grocery foods that were high in fibre and low in fat, salt and sugar; and they purchased a smaller variety of fruits. There was no evidence of an association between area SES and vegetable variety.ConclusionsIn Melbourne, area SES was associated with some food purchasing behaviours independent of individual-level factors, suggesting that areas in this city may be differentiated on the basis of food availability, accessibility and affordability, making the purchase of some types of foods more difficult in disadvantaged areas.

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