The influence of socioeconomic status on change in health status after hospitalization.
We reviewed patients' hospital records and surveyed patients after hospital discharge to determine whether the experience of being hospitalized differentially affected the health status of persons with different socioeconomic backgrounds (as measured by income level and education level) and to determine whether the association between socioeconomic status (SES) and change in health status varied depending upon the reason for hospital admission. We studied patients admitted to six university-affiliated teaching hospitals in Massachusetts and California for chest pain (N = 797) and surgery (N = 1165). We compared the health status scores of patients for a variety of outcomes: basic activities of daily living, instrumental activities of daily living, social activities, mental well-being, work performance and housework performance. Lower-SES patients entered the hospital with worse health status than higher-SES patients. Change in health status, statistically adjusted for case-mix, varied by reason for admission. Patients with chest pain generally reported either no improvement or a decline in functioning with the amount of decline equivalent for low- and high-SES patients. Surgical patients reported improvement in functioning following hospitalization. For several measures, lower-income surgical patients reported greater improvement than did higher-income patients, but still did not reach the same level of health status as higher-income patients.
Guadagnoli
E
E
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Cleary
P D
PD
McNeil
B J
BJ
D000203:Activities of Daily Living / Q000145:classification; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002637:Chest Pain / Q000191:economics; D017281:Cost of Illness; D005260:Female; D006304:Health Status; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011788:Quality of Life; D012959:Socioeconomic Factors; D013514:Surgical Procedures, Operative / Q000191:economics