Country of birth, socioeconomic position, and healthcare expenditure: a multilevel analysis of Malmo, Sweden
Open Access
- 1 February 2004
- journal article
- research article
- Published by BMJ in Journal of Epidemiology and Community Health
- Vol. 58 (2) , 145-149
- https://doi.org/10.1136/jech.58.2.145
Abstract
Study objective: The principle of equity aims to guarantee allocation of healthcare resources on the basis of need. Therefore, people with a low income and persons living alone are expected to have higher healthcare expenditures. Besides these individual characteristics healthcare expenditure may be influenced by country of birth. This study therefore aimed to investigate the role of country of birth in explaining individual healthcare expenditure. Design: Multilevel regression model based on individuals (first level) and their country of birth (second level). Setting: The city of Malmö, Sweden. Participants: All the 52 419 men aged 40–80 years from 130 different countries of birth, who were living in Malmö, Sweden, during 1999. Main results: At the individual level, persons with a low income and persons living alone showed a higher healthcare expenditure, with regression coefficients (and 95% confidence intervals) being 0.358 (0.325 to 0.392) and 0.197 (0.165 to 0.230), respectively. Country of birth explained a considerable part (18% and 13%) of the individual differences in the probability of having a low income and living alone, respectively. However, this figure was only 3% for having some health expenditure, and barely 0.7% with regard to costs in the 74% of the population with some health expenditure. Conclusions: Malmö is a socioeconomically segregated city, in which the country of birth seems to play only a minor part in explaining individual differences in total healthcare expenditure. These differences seem instead to be determined by individual low income and living alone.Keywords
This publication has 13 references indexed in Scilit:
- Multilevel analytical approaches in social epidemiology: measures of health variation compared with traditional measures of associationJournal of Epidemiology and Community Health, 2003
- Immigrants in the Netherlands: Equal access for equal needs?Journal of Epidemiology and Community Health, 2001
- Is there equity in access to health services for ethnic minorities in Sweden?European Journal of Public Health, 2001
- Is research into ethnicity and health racist, unsound, or important science?BMJ, 1997
- Long-term illness among indigenous and foreign-born people in SwedenSocial Science & Medicine, 1997
- Multilevel Models: Applications to Health DataJournal of Health Services Research & Policy, 1996
- Health-related behaviour in context: A multilevel modelling approachSocial Science & Medicine, 1996
- Ethnicity as a variable in epidemiological researchBMJ, 1994
- Ethnicity as a risk factor for consultations in primary health care and out-patient careScandinavian Journal of Primary Health Care, 1993
- Assessing social networks and social support in epidemiologic studies.1987