Is socioeconomic position associated with hospital admissions? findings from a population-based cross-sectional study among middle-aged and older Malaysians.

Abstract

Guided by the Andersen Behavioural Model of Healthcare Utilisation, this study investigated the relationship between socioeconomic status, enabling factors and need factors in predicting hospital admission. Data were analysed from the first wave of the Malaysia Ageing and Retirement Survey (MARS), a longitudinal cohort study. 5612 Malaysian adults aged 40 and older participated in MARS. A Generalised Structural Equation Modelling was applied to test associations between socioeconomic status (financial well-being and education levels), enablers and need factors with hospital admission. The weighted coefficients, SEs and 95% CIs were reported. The role of the enablers as mediators was tested. Analysis was performed using STATA v.18. Socioeconomic status did not affect hospital admission. Better financial well-being lowered functional impairment (β=-0.006, 95% CI -0.009 to -0.003) and better cognitive status (β=0.130, 95% CI 0.109 to 0.152) with no significant effect on the number of chronic diseases. Higher education improved cognitive function (β=2.387, 95% CI 2.081 to 2.693) but was not associated with functional impairment or the number of chronic diseases. Worsening functional impairment and a higher number of chronic conditions predicted higher hospital admissions. A better cognitive status reduces it. Outlook on life mediated the effect between financial well-being and education levels with hospital admission (β=-0.002, 95% CI -0.004 to -0.001 for financial well-being and β=-0.019, 95% CI -0.036 to -0.006 for education). Hospital admissions were driven by health needs, regardless of socioeconomic status, highlighting the importance of promoting primary prevention of diseases.