Occupational class differences in later life hospital use by women who survived to age 80: the Renfrew & Paisley prospective cohort study

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Hart, Carole L. ; McCartney, Gerry ; Watt, Graham C.M. (2014)

<b>Background</b> Population ageing challenges the sustainability of healthcare provision.<p></p>\ud \ud <b>Objective</b> To investigate occupational class differences in hospital use in women aged 80+ years.<p></p>\ud \ud <b>Methods</b> 8353 female residents, aged 45-64, took part in the Renfrew and Paisley prospective cohort study in 1972-76. Information on general and mental health hospital discharges was provided from computerised linkage with the Scottish Morbidity Records data to 31/12/2012. Numbers of admissions and bed-days after the 80th birthday were calculated for all and specific causes. Rate ratios by occupational class were calculated using negative binomial regression analysis, adjusting for age and a range of risk factors.<p></p>\ud \ud <b>Results</b> 4,407 (56%) women survived to age 80 and had 17,563 general admissions thereafter, with a mean stay of 19.4 days. There were no apparent relationships with occupational class for all general admissions, but lower occupational class was associated with higher rate ratios for coronary heart disease and stroke and lower rate ratios for cancer. Adjustment for risk factors could not fully explain the raised rate ratios. Bed-day use was higher in lower occupational classes, especially for stroke. There were strong associations with mental health admissions, especially dementia. Compared with the highest occupational class, admission rate ratios for dementia were higher for the lowest occupational class (adjusted rate ratio =2.60, 95% confidence interval 1.79 to 3.77).<p></p>\ud \ud <b>Conclusion</b>\ud In this population, there were no socioeconomic gradients seen in hospital utilisation for general admissions in old age. However, occupational class was associated with mental health admissions, coronary heart disease, stroke and cancer.<p></p>
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