AbstractBackgroundSocial factors are recognized determinants of morbidity and mortality and also have an impact on use of medical services. Low education level and lack of social and financial resources have been associated with prolonged hospital stays while for migration factors evidence is inconclusive. The objective of this study was i) to assess the associations of social factors with length of hospital stays for chronic conditions, ii) to investigate the role of comorbidity and discharge destination in mediating these associations and iii) to identify the main drivers of length of stays.MethodsThis analysis made use of nationwide inpatient data from Swiss hospital discharge statistics that was linked on the individual level with Swiss census data. The study sample included n=141,307 records of n=92,623 inpatients aged 25 to 84 years, hospitalized between 2010 and 2016 for acute care in Switzerland with a main diagnosis of one of 15 selected chronic conditions, including cancers and cardiovascular, respiratory and musculoskeletal diseases. Cross-classified multilevel models were used to assess the impact of social factors on length of hospital stay and for mediation analysis in the retrospective inpatient cohort.FindingsThe strongest determinants of length of stay were medical factors, namely main diagnosis (up to seven days difference), comorbidities (up to 10 days) and treatment-related factors (two to three days). Also, social factors were associated with duration of hospital stays. Taking into account demographic factors, main diagnosis and clustering on patient and hospital level, patients with upper secondary and compulsory education stayed longer in hospital compared to those with tertiary education (β 0.24 days, 95% CI 0.14-0.33; β 0.37, 95% CI 0.27-0.47, respectively). However, these effects were almost fully mediated by burden of comorbidity. The effect of living alone on length of stay (β 0.60 days, 95% CI 0.50-0.70) was partially mediated by both burden of comorbidities (33%) and discharge destination (30.4%). (Semi-) private insurance was associated with prolonged stays, but an inverse effect was observed for colon and breast cancer. Allophone patients, first generation migrants and non-EU/EFTA-nationals had also prolonged hospital stays (β 0.34, 95% CI 0.13-0.55; β 0.16, 95% CI 0.05-0.27; β 0.22, 95% CI 0.02, 0.42, resp.).ConclusionsHospital stays could be a window of opportunity to discern patients with low health literacy who need additional instructions and support to better cope with everyday life after discharge, reducing the risks of future hospital stays. However, inpatient care in Switzerland seems to take into account rather obvious individual needs such as interpreter services or rehabilitation due to lack of language skills or lack of immediate support at home, respectively, but not necessarily more hidden needs of patients with low health literacy and less resources to assert their interests within the health system. Our findings underpin the importance of health policies promoting shared decision making and patient-centred care tailored to the differential needs of social and cultural groups.
Role of Autologous Fibrin Glue (AFG) to Reduce Drainage Volume After Modified Radical Mastectomy for Breast Cancer
