Socioeconomic differences in waiting times for elective surgery: a population-based retrospective studyReport as inadecuate

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BMC Health Services Research

, 12:268

First Online: 21 August 2012Received: 13 February 2012Accepted: 19 June 2012DOI: 10.1186-1472-6963-12-268

Cite this article as: Petrelli, A., De Luca, G., Landriscina, T. et al. BMC Health Serv Res 2012 12: 268. doi:10.1186-1472-6963-12-268


BackgroundWidespread literature on inequity in healthcare access and utilization has been published, but research on socioeconomic differences in waiting times is sparse and the evidence is fragmentary and controversial. The objective of the present study is the analysis of the relationship between individual socioeconomic level and waiting times for in-hospital elective surgery.

MethodsWe retrospectively studied the waiting times experienced by patients registered on hospital waiting lists for 6 important surgical procedures by using the Hospital Discharge Database HDD of the Piedmont Region 4,000,000 inhabitants in the North West of Italy from 2006 to 2008. The surgical procedures analyzed were: coronary artery by-pass CABG, angioplasty, coronarography, endarterectomy, hip replacement and cholecystectomy. Cox regression models were estimated to study the relationship between waiting times and educational level taking into account the confounding effect of the following factors: sex, age, comorbidity, registration period, and Local Health Authorities LHA as a proxy of supply.

ResultsMedian waiting times for low educational level were higher than for high educational level for all the selected procedures. Differences were particularly high for endarterectomy and hip replacement. For all considered procedures, except CABG, an inverse gradient between waiting times and educational level was observed: the conditional probabilities of undergoing surgery were lower among individuals with a low to middle level education than for individuals with a higher level of education after adjustment for sex, age, comorbidities, registration period, and LHAs. For most procedures the effect decreases over the follow up period.

ConclusionsThe results of the study show evidence of inequalities in access to elective surgery in Italy. Implementation of policies aimed to promote national information initiatives that guarantee wider access to those with low socio-economic status is strongly recommended.

KeywordsEquity Access Duration analysis Waiting times Socioeconomic status  Download fulltext PDF

Author: Alessio Petrelli - Giuliana De Luca - Tania Landriscina - Giuseppe Costa


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