Social factors are recognized determinants of morbidity and mortality and also have an impact on use of medical services. The objective of this study was to assess the associations of educational attainment, social and financial resources, and migration factors with length of hospital stays for chronic conditions. In addition, the study investigated the role of comorbidity and discharge destination in mediating these associations. The study made use of nationwide inpatient data that was linked with Swiss census data.
Cross-classified multilevel models and mediation analysis were performed. However, these effects were almost fully mediated by burden of comorbidity. Semi- private insurance was associated with prolonged stays, but an inverse effect was observed for colon and breast cancer. Hospital stays could be a window of opportunity to discern patients who need additional time and support to better cope with everyday life after discharge, reducing the risks of future hospital stays.
However, inpatient care in Switzerland seems to take into account rather obvious individual needs due to lack of immediate support at home, but not necessarily more hidden needs of patients with low health literacy and less resources to assert their interests within the health system. Citation: Bayer-Oglesby L, Zumbrunn A, Bachmann N, on behalf of the SIHOS Team Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland.
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The supporting information file S1 File contains the description of the data sources and the specification of the variables that need to be requested from the SFSO. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Social factors are major determinants of morbidity and mortality in Europe and worldwide [ 1 , 2 ].
