title: Distance to hospital and socioeconomic status influence secondary health care use.
abstract: OBJECTIVE
  The aim of this study was to investigate how distance to hospital and socioeconomic status (SES) influence the use of secondary health care (SHC) when taking comorbidity into account.
  
  
  METHODS
  A register-based study in Östergötland County.
  
  
  METHODS
  The adult population of Östergötland County.
  
  
  METHODS
  Odds of SHC use in the population and ates of SHC use by patients were studied after taking into account comorbidity level assigned using the Adjusted Clinical Groups (ACG) Case-Mix System. The baseline for analysis of SES was individuals with the lowest education level (level 1) and the lowest income (1st quartile).
  
  
  RESULTS
  The study showed both positive and negative association between SES and use of SHC. The risk of incurring SHC costs was 12% higher for individuals with education level 1. Individuals with income in the 2nd quartile had a 4% higher risk of incurring SHC costs but a 17% lower risk of emergency department visits. Individuals with income in the 4th quartile had 9% lower risk of hospitalization. The risk of using SHC services for the population was not associated with distance to hospital. Patients living over 40 km from hospital and patients with higher SES had lower use of SHC services.
  
  
  CONCLUSIONS
  It was found that distance to hospital and SES influence SHC use after adjusting for comorbidity level, age, and gender. These results suggest that GPs and health care managers should pay a higher degree of attention to this when planning primary care services in order to minimize the potentially redundant use of SHC.
authors.affiliation: Blekinge Centre of Competence, Karlskrona, Sweden. andrzej.zielinski@ltblekinge.se
authors.forename: Andrzej
authors.initials: A
authors.lastname: Zielinski
authors.forename: Lars
authors.initials: L
authors.lastname: Borgquist
authors.forename: Anders
authors.initials: A
authors.lastname: Halling
mesh_terms: D000328:Adult; D015897:Comorbidity; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013548:Sweden; D055815:Young Adult