Socioeconomic and citizenship inequalities in hospitalisation of the adult population in Italy

BACKGROUND: Higher levels of hospital admissions among people with lower socioeconomic level, including immigrants, have been observed in developed countries. In Europe, immigrants present a more frequent use of emergency services compared to the native population. The aim of our study was to evaluate the socioeconomic and citizenship differences in the hospitalisation of the adult population in Italy. METHODS: The study was conducted using the database created by the record linkage between the National Health Interview Survey (2005) with the National Hospital Discharge Database (2005-2014). 79,341 individuals aged 18-64 years were included. The outcomes were acute hospital admissions, urgent admissions and length of stay (1-7 days, > = 8 days). Education level, occupational status, self-perceived economic resources and migratory status were considered as socioeconomic determinants. A multivariate proportional hazards model for recurrent events was used to estimate the risk of total hospital admissions. Logistic models were used to estimate the risk of urgent hospitalisation as well as of length of stay. RESULTS: Low education level, the lack of employment and negative self-perceived economic resources were conditions associated with the risk of hospitalisation, a longer hospital stay and greater recourse to urgent hospitalisation. Foreigners had a lower risk of hospitalisation (HR = 0.75; 95% CI:0.68-0.83) but a higher risk of urgent hospitalisation (OR = 1.36; 95% CI:1.18-1.55) and more frequent hospitalisations with a length of stay of at least eight days (OR = 1.19; 95% CI:1.02-1.40). CONCLUSIONS: To improve equity in access, effective primary, secondary and tertiary prevention strategies must be strengthened, as should access to appropriate levels of care.