Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Dec 11;9:457.
doi: 10.1186/1471-2458-9-457.

Income Level and Chronic Ambulatory Care Sensitive Conditions in Adults: A Multicity Population-Based Study in Italy

Collaborators, Affiliations
Free PMC article

Income Level and Chronic Ambulatory Care Sensitive Conditions in Adults: A Multicity Population-Based Study in Italy

Nera Agabiti et al. BMC Public Health. .
Free PMC article

Abstract

Background: A relationship between quality of primary health care and preventable hospitalizations has been described in the US, especially among the elderly. In Europe, there has been a recent increase in the evaluation of Ambulatory Care Sensitive Conditions (ACSC) as an indicator of health care quality, but evidence is still limited. The aim of this study was to determine whether income level is associated with higher hospitalization rates for ACSC in adults in a country with universal health care coverage.

Methods: From the hospital registries in four Italian cities (Turin, Milan, Bologna, Rome), we identified 9384 hospital admissions for six chronic conditions (diabetes, hypertension, congestive heart failure, angina pectoris, chronic obstructive pulmonary disease, and asthma) among 20-64 year-olds in 2000. Case definition was based on the ICD-9-CM coding algorithm suggested by the Agency for Health Research and Quality - Prevention Quality Indicators. An area-based (census block) income index was used for each individual. All hospitalization rates were directly standardised for gender and age using the Italian population. Poisson regression analysis was performed to assess the relationship between income level (quintiles) and hospitalization rates (RR, 95% CI) separately for the selected conditions controlling for age, gender and city of residence.

Results: Overall, the ACSC age-standardized rate was 26.1 per 10.000 inhabitants. All conditions showed a statistically significant socioeconomic gradient, with low income people being more likely to be hospitalized than their well off counterparts. The association was particularly strong for chronic obstructive pulmonary disease (level V low income vs. level I high income RR = 4.23 95%CI 3.37-5.31) and for congestive heart failure (RR = 3.78, 95% CI = 3.09-4.62). With the exception of asthma, males were more vulnerable to ACSC hospitalizations than females. The risks were higher among 45-64 year olds than in younger people.

Conclusions: The socioeconomic gradient in ACSC hospitalization rates confirms the gap in health status between social groups in our country. Insufficient or ineffective primary care is suggested as a plausible additional factor aggravating inequality. This finding highlights the need for improving outpatient care programmes to reduce the excess of unnecessary hospitalizations among poor people.

Similar articles

See all similar articles

Cited by 28 articles

See all "Cited by" articles

References

    1. Purdy S, Griffin T, Salisbury C, Sharp D. Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians. Public Health. 2009;123:169–73. doi: 10.1016/j.puhe.2008.11.001. Review. - DOI - PubMed
    1. Sanderson C, Dixon J. Conditions for which onset or hospital admission is potentially preventable by timely and effective ambulatory care. J Health Serv Res Policy. 2000;5:222–30. Review. - PubMed
    1. Caminal J, Starfield B, Sánchez E, Casanova C, Morales M. The role of primary care in preventing ambulatory care sensitive conditions. Eur J Public Health. 2004;14:246–51. doi: 10.1093/eurpub/14.3.246. - DOI - PubMed
    1. Laditka JN, Laditka SB, Probst JC. More may be better: evidence of a negative relationship between physician supply and hospitalization for ambulatory care sensitive conditions. Health Serv Res. 2005;40:1148–1166. doi: 10.1111/j.1475-6773.2005.00403.x. - DOI - PMC - PubMed
    1. Backus L, Moron M, Bacchetti P, Baker LC, Bindman AB. Effect of managed care on preventable hospitalization rates in California. Med Care. 2002;40:315–24. doi: 10.1097/00005650-200204000-00007. - DOI - PubMed

Publication types

Feedback