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Healthcare inequalities in emergency visits and hospitalisation at the end of life: a study of 395 019 public hospital records
  1. Roger Yat-Nork Chung1,2,3,
  2. Derek Chun Kiu Lai3,
  3. Alvin Yik-Kiu Hui1,
  4. Patsy Yuen-Kwan Chau1,
  5. Eliza Lai-Yi Wong1,
  6. Eng-Kiong Yeoh1,2 and
  7. Jean Woo2,3
  1. 1The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  2. 2CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  3. 3CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  1. Correspondence to Professor Roger Yat-Nork Chung, The Chinese University of Hong Kong The Jockey Club School of Public Health and Primary Care, Hong Kong, Hong Kong; rychung{at}cuhk.edu.hk

Abstract

Objectives To investigate whether there were any socioeconomic disparities in utilisation of hospital care services during end of life in Hong Kong.

Methods Secondary data analyses were conducted using frequency of the accident and emergency (A&E) department visits and hospital admissions during the last year of life in all public hospitals from 2004 to 2014 in Hong Kong. A total of 1 237 044 A&E records from 357 853 patients, and 1 878 982 admission records from 375 506 patients were identified for analyses. In total, 395 019 unique deceased patients were identified from both datasets.

Results Regression analyses showed that comprehensive social security assistance (CSSA) recipients used A&E services 1.29 times more than the non-recipients. Being either a CSSA recipient or an elderly home resident was more likely to be admitted to hospitals and stayed longer. Elderly home residents tended to stay longer than those from the community in the earlier months during the last year of life regardless of CSSA status; however, non-elderly home residents surpassed the residents in the duration of stay at hospitals towards the later months of the last year of life. There were also significant differences in hospital utilisation across various districts of residence.

Conclusions People of lower socioeconomic position tend to have higher emergency visits and hospitalisation during their last year of life in Hong Kong, implying the presence of health inequality during end of life. However, due to Hong Kong’s largely pro-rich primary care system, the predominantly public A&E and inpatient services may inadvertently act as a mitigator of such health inequalities.

  • hospice care
  • terminal care
  • end of life care
  • hospital care

Data availability statement

Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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Footnotes

  • Funding The work described in this paper was fully supported by a commissioned grant from the Health and Medical Research Fund (HMRF) of the Food and Health Bureau of the Government of the Hong Kong Special Administrative Region and the Research Grants Council of the Hong Kong Special Administrative Region, China (Project Code: Elderly Care CUHK).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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