How do patients' incomes relate to hospital admissions?

The richest and poorest people in Toronto are hospitalized for different reasons, says a new study led by U of T researchers.

And different hospitals are serving different income groups, the study found.

“Very low-income people are using the parts of the health care system that are in greatest crisis,” said Dr. Rick Glazier, one of the lead authors of the study and a professor with the department of family & community medicine at the University of Toronto’s Faculty of Medicine. “It’s all the more reason to think broadly about what keeps people healthy in the first place.”

More wealthy patients received same-day surgeries than low-income patients, the study found. In contrast, more low-income patients were hospitalized for mental health issues, visited emergency departments for non-urgent issues and remained in acute care hospital beds while waiting to be transferred to more appropriate levels of care in the community such as nursing homes.

This report will enable many Toronto hospitals and health care stakeholders to see the socioeconomic profile of patients for the first time, Glazier said. That information will allow them to see whether patient outcomes are linked to incomes, he said, and give them the opportunity to tailor care to the needs of their current patient population and work with others to plan health services appropriate for the community.

“We want a universal health care system that helps everyone be healthy, regardless of how much money they earn,” said Glazier, a researcher at the Centre for Research on Inner City Health (CRICH) at St. Michael’s Hospital and a senior scientist at the Institute for Clinical Evaluative Sciences (ICHS).  “But until we actually look at social differences among patients, it’s impossible to say if hospital care is equitable or if hospitals have the proper resources to respond to the patients they serve.”

Glazier said the statistics point to the social causes of disease and strains on the health system.

“What health supports do wealthy groups enjoy that those with lower incomes lack?” Glazier said. “Access to primary health care, the ability to pay for healthy foods and medicines and to live in a healthy place where you can receive home care if you need it?

“We think that addressing upstream areas like these will likely make an impact on hospital use.”

The researchers examined data on all patients admitted between 2008 and 2010 to 20 hospitals in the Toronto Central Local Health Integration Network.

They found hospitals fell into three categories: those who treat high-income and low-income patients in the same numbers; those who treat mainly low-income patients; and those who treat mainly high-income patients. In all of the hospitals surveyed, middle-income patients were served the least.

Among their other findings:
• In almost every hospital, surgical patients had higher incomes than medical patients
• More wealthy patients than poor patients had day surgery.
• More low-income patients than high-income patients were admitted for mental health services at almost every hospital 
• Patients designated as waiting for “alternate level of care,” meaning they occupy an acute hospital bed but do not require the intensity of resources or services provided in that setting, were more likely to have low incomes than high incomes. In most of the hospitals, ALC patients had lower incomes than the hospital’s overall patient population
• Overall, more low-income patients visited emergency departments than high-income patients for non-urgent reasons.

The study was conducted by CRICH and ICES in partnership with the Hospital Collaborative on Marginalized and Vulnerable Populations.

Hospitals in Ontario do not collect data on patient incomes; researchers obtained the income information by linking postal codes to household incomes reported in the census. According to that data, the median income of the highest 20 per cent of households in the Central Toronto LHIN was $101,000. The median income for the lowest 20 per cent was $35,000.