Is socioeconomic position associated with hospital admissions? findings from a population-based cross-sectional study among middle-aged and older Malaysians

OBJECTIVES: Guided by the Andersen Behavioural Model of Healthcare Utilisation, this study investigated the relationship between socioeconomic status, enabling factors and need factors in predicting hospital admission. DESIGN AND SETTING: Data were analysed from the first wave of the Malaysia Ageing and Retirement Survey (MARS), a longitudinal cohort study. PARTICIPANTS: 5612 Malaysian adults aged 40 and older participated in MARS. OUTCOME MEASURES: A Generalised Structural Equation Modelling was applied to test associations between socioeconomic status (financial well-being and education levels), enablers and need factors with hospital admission. The weighted coefficients, SEs and 95% CIs were reported. The role of the enablers as mediators was tested. Analysis was performed using STATA v.18. RESULTS: Socioeconomic status did not affect hospital admission. Better financial well-being lowered functional impairment (β=-0.006, 95% CI -0.009 to -0.003) and better cognitive status (β=0.130, 95% CI 0.109 to 0.152) with no significant effect on the number of chronic diseases. Higher education improved cognitive function (β=2.387, 95% CI 2.081 to 2.693) but was not associated with functional impairment or the number of chronic diseases. Worsening functional impairment and a higher number of chronic conditions predicted higher hospital admissions. A better cognitive status reduces it. Outlook on life mediated the effect between financial well-being and education levels with hospital admission (β=-0.002, 95% CI -0.004 to -0.001 for financial well-being and β=-0.019, 95% CI -0.036 to -0.006 for education). CONCLUSION: Hospital admissions were driven by health needs, regardless of socioeconomic status, highlighting the importance of promoting primary prevention of diseases.