Dear Colleagues
attached below information and abstract from paper in latest edition of JCEH which some of you may find of interest
Best wishes
David McDaid
LSE Health and Social Care
J Epidemiol Community Health -- Table of Contents Alert
1 February 2002; Vol. 56, No. 2
URL: http://jech.bmjjournals.com/content/vol56/issue2/index.shtml
Socioeconomic differences in children's and adolescents' hospital admissions in Germany: a report based on health insurance data on selected diagnostic categories
S Geyer, R Peter, and J Siegrist
J Epidemiol Community Health 2002;56 109-114
http://jech.bmjjournals.com/cgi/content/abstract/56/2/109
Abstract
Correspondence to:
Dr S Geyer, Medizinische Soziologie OE 5443, Medizinische Hochschule Hannover, 30625 Hannover, Germany;
geyer.siegfried@ mh-hannover.de
Study objective: The extent of social inequalities in children's hospitalisation risks was examined in terms of socioeconomic
status and parents' nationality. This was considered in terms of inpatient treatment attributable to a number of diagnoses
(ICD-9), especially infectious diseases and psychiatric disorders.
Design and setting: Analyses were performed with records of a German statutory health insurance comprising 48 412 (52.8%
male and 47.2% female) children and adolescents of 15 years of age or younger who were co-insured between 1987 and
1996. Classification of socioeconomic position was based on parental occupational position.
Results: Social inequalities in terms of hospital admissions attributable to acute diseases were rather small. The only exception
were infections of the respiratory organs: in the highest status positions as compared with the lowest one the relative risk for
being admitted was RR=0.22 (95% CI 0.06 to 0.89). However, length of stay in hospital was significantly related to
socioeconomic position for infections of the upper respiratory tract and infections of the respiratory organs, with children and
adolescents with the lowest socioeconomic background having spent the longest periods in hospital. With regard to nationality,
pneumonia/flu was the only diagnostic category where relative risks for being admitted were higher in non-German children and
adolescents (RR=1.5; 95% CI 1.2 to 1.8). Conversely, hospital admissions attributable to psychiatric diagnoses were
significantly lower among non-German patients (RR=0.43; 95% CI 0.30 to 0.61), thus suggesting differential utilisation patterns
according to nationality.
Conclusions: Health inequalities in children's and adolescents' hospital admissions in Germany are small and inconsistent if
parents' socioeconomic status and nationality are taken as criterion. Yet, children of lower status background stay longer in
hospital if suffering from highly prevalent infectious diseases. This last observation may be attributable to more severe disease
conditions.
Keywords: morbidity; social inequality; children; adolescents; infectious diseases; psychiatric disorders
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