Bachmann, Nicole
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Soziale Unterschiede in der Spitalversorgung chronisch kranker Menschen in der Schweiz
2023, Bayer-Oglesby, Lucy, Bachmann, Nicole, Zumbrunn, Andrea, Solèr, Maria
Die NFP-74-Studie “Social Inequalities and Hospitalisations in Switzerland (SIHOS)” untersuchte zum ersten Mal in der Schweiz soziale Ungleichheiten bei Spitalaufenthalten auf der Basis von repräsentativen landesweiten Daten auf Individualebene.
Social disparities in unplanned 30-day readmission rates after hospital discharge in patients with chronic health conditions: A retrospective cohort study using patient level hospital administrative data linked to the population census in Switzerland
2022-09-22, Zumbrunn, Andrea, Bachmann, Nicole, Bayer-Oglesby, Lucy, Joerg, Reto
Unplanned readmissions shortly after discharge from hospital are common in chronic diseases. The risk of readmission has been shown to be related both to hospital care, e.g., medical complications, and to patients’ resources and abilities to manage the chronic disease at home and to make appropriate use of outpatient medical care. Despite a growing body of evidence on social determinants of health and health behaviour, little is known about the impact of social and contextual factors on readmission rates. The objective of this study was to analyse possible effects of educational, financial and social resources of patients with different chronic health conditions on unplanned 30 day-readmission risks. The study made use of nationwide inpatient hospital data that was linked with Swiss census data. The sample included n = 62,109 patients aged 25 and older, hospitalized between 2012 and 2016 for one of 12 selected chronic conditions. Multivariate logistic regressions analysis was performed. Our results point to a significant association between social factors and readmission rates for patients with chronic conditions. Patients with upper secondary education (OR = 1.26, 95% CI: 1.11, 1.44) and compulsory education (OR = 1.51, 95% CI: 1.31, 1.74) had higher readmission rates than those with tertiary education when taking into account demographic, social and health status factors. Having private or semi-private hospital insurance was associated with a lower risk for 30-day readmission compared to patients with mandatory insurance (OR = 0.81, 95% CI: 0.73, 0.90). We did not find a general effect of social resources, measured by living with others in a household, on readmission rates. The risk of readmission for patients with chronic conditions was also strongly predicted by type of chronic condition and by factors related to health status, such as previous hospitalizations before the index hospitalization (+77%), number of comorbidities (+15% higher probability per additional comorbidity) as well as particularly long hospitalizations (+64%). Stratified analysis by type of chronic condition revealed differential effects of social factors on readmissions risks. Compulsory education was most strongly associated with higher odds for readmission among patients with lung cancer (+142%), congestive heart failure (+63%) and back problems (+53%). We assume that low socioeconomic status among patients with chronic conditions increases the risk of unplanned 30-day readmission after hospitalisation due to factors related to their social situation (e.g., low health literacy, material deprivation, high social burden), which may negatively affect cooperation with care providers and adherence to recommended therapies as well as hamper active participation in the medical process and the development of a shared understanding of the disease and its cure. Higher levels of comorbidity in socially disadvantaged patients can also make appropriate self-management and use of outpatient care more difficult. Our findings suggest a need for increased preventive measures for disadvantaged populations groups to promote early detection of diseases and to remove financial or knowledge-based barriers to medical care. Socially disadvantaged patients should also be strengthened more in their individual and social resources for coping with illness.
Soziale Ungleichheit und Covid-19. Schwere Covid-19-Verläufe mit Spitalaufenthalt und der Einfluss von Demografie, Vorerkrankung, Sozialstatus und Expositionsrisiken
2024, Bayer-Oglesby, Lucy, Bachmann, Nicole, Sepahniya, Samin, Jörg, Reto
Das Bulletin untersucht soziale Ungleichheiten in der Covid-19-Pandemie. Auf Basis einer Datenverknüpfung zwischen der Strukturerhebung (SE) und der Medizinischen Statistik (MS) wird untersucht, welche Teile der Schweizer Bevölkerung in den Pandemiejahren 2020 und 2021 ein erhöhtes Risiko für einen Spitalaufenthalt wegen Covid-19 aufwiesen und welche Rolle dabei die soziale Lage, die Wohnsituation und der Beruf spielten. Ausserdem thematisiert das Bulletin die Rolle schwerer Vorerkrankungen und zeigt auf, wie sich die sozialen Ungleichheiten bei schweren Covid-19-Verläufen mit der Zugänglichkeit von Impfungen verändert haben.
Lebensqualität versus Lebensschutz bei Menschen mit Beeinträchtigungen während der Covid-19-Pandemie. Studie im Auftrag des Bundesamts für Gesundheit
2023, Büschi, Eva, Bachmann, Nicole, Bayer-Oglesby, Lucy, Hess, Nadja, Hug, Sonja, Knobel Furrer, Christina, Lichtenauer, Annette, Moramana, Nadja
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