Educational differences in long-term care use in Sweden during the last two years of life

Background: In old age, many people experience a period of functional decline and require long-term care. Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long...

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Published in:Scandinavian journal of public health 2023-06, Vol.51 (4), p.579-586
Main Authors: Kelfve, Susanne, Wastesson, Jonas W., Meinow, Bettina
Format: Article
Language:English
Subjects:
Aged
Data Collection
Educational Status
Female
Home Care Services
Humans
Long-Term Care
Male
Original
Sweden - epidemiology
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creator Kelfve, Susanne
Wastesson, Jonas W.
Meinow, Bettina
description Background: In old age, many people experience a period of functional decline and require long-term care. Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. Methods: We used linked register data on mortality and long-term care use, including all adults aged ⩾67 years who died in Sweden in November 2015 (N=6329). We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Men and women were analysed separately. Results: People with tertiary education died more commonly without using any long-term care compared to primary educated people (28.0% vs. 18.6%; p
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Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. Methods: We used linked register data on mortality and long-term care use, including all adults aged ⩾67 years who died in Sweden in November 2015 (N=6329). We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Men and women were analysed separately. Results: People with tertiary education died more commonly without using any long-term care compared to primary educated people (28.0% vs. 18.6%; p&lt;0.001). In the adjusted model, educational differences in the estimated number of months with long-term care disappeared among men but remained significant among women (primary educated: odds ratio=17.3 (confidence interval 16.8–17.7); tertiary educated: odds ratio=15.8 (confidence interval 14.8–16.8)). Conclusions: Older adults spend considerable time in their last two years of life with long-term care. Only minor educational differences in long-term care use remained after adjustment for cohabitation status and age at death. This suggest that Sweden’s publicly financed long-term system achieves relatively equitable use of long-term care at the end of life.</description><identifier>ISSN: 1403-4948</identifier><identifier>ISSN: 1651-1905</identifier><identifier>EISSN: 1651-1905</identifier><identifier>DOI: 10.1177/14034948211043658</identifier><identifier>PMID: 34590503</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Aged ; Data Collection ; Educational Status ; Female ; Home Care Services ; Humans ; Long-Term Care ; Male ; Original ; Sweden - epidemiology</subject><ispartof>Scandinavian journal of public health, 2023-06, Vol.51 (4), p.579-586</ispartof><rights>Author(s) 2021</rights><rights>Author(s) 2021 2021 Associations of Public Health in the Nordic Countries Regions</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c515t-b33096df77e8c279c1e4b1dd6cffb0146c7df6fa9ae17b4150f2a4dff6e2a5b63</citedby><cites>FETCH-LOGICAL-c515t-b33096df77e8c279c1e4b1dd6cffb0146c7df6fa9ae17b4150f2a4dff6e2a5b63</cites><orcidid>0000-0001-9369-1928 ; 0000-0002-2059-9474</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904,79111</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34590503$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-180378$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:147800188$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Kelfve, Susanne</creatorcontrib><creatorcontrib>Wastesson, Jonas W.</creatorcontrib><creatorcontrib>Meinow, Bettina</creatorcontrib><title>Educational differences in long-term care use in Sweden during the last two years of life</title><title>Scandinavian journal of public health</title><addtitle>Scand J Public Health</addtitle><description>Background: In old age, many people experience a period of functional decline and require long-term care. Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. Methods: We used linked register data on mortality and long-term care use, including all adults aged ⩾67 years who died in Sweden in November 2015 (N=6329). We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Men and women were analysed separately. Results: People with tertiary education died more commonly without using any long-term care compared to primary educated people (28.0% vs. 18.6%; p&lt;0.001). In the adjusted model, educational differences in the estimated number of months with long-term care disappeared among men but remained significant among women (primary educated: odds ratio=17.3 (confidence interval 16.8–17.7); tertiary educated: odds ratio=15.8 (confidence interval 14.8–16.8)). Conclusions: Older adults spend considerable time in their last two years of life with long-term care. Only minor educational differences in long-term care use remained after adjustment for cohabitation status and age at death. This suggest that Sweden’s publicly financed long-term system achieves relatively equitable use of long-term care at the end of life.</description><subject>Aged</subject><subject>Data Collection</subject><subject>Educational Status</subject><subject>Female</subject><subject>Home Care Services</subject><subject>Humans</subject><subject>Long-Term Care</subject><subject>Male</subject><subject>Original</subject><subject>Sweden - epidemiology</subject><issn>1403-4948</issn><issn>1651-1905</issn><issn>1651-1905</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><recordid>eNp9kUtv1TAQhSMEoqXwA9ggL9mkeBK_skJVKQ-pEgseEivLscepS65d7ISr_nt8dS8VFVJXHs1854zt0zQvgZ4CSPkGGO3ZwFQHQFkvuHrUHIPg0MJA-eNa13m7A46aZ6VcU0oF69TT5qhnvBK0P25-XLjVmiWkaGbigveYMVosJEQypzi1C-YNsSYjWQvuul-26DASt-YQJ7JcIZlNWciyTeQWTS4keTIHj8-bJ97MBV8czpPm2_uLr-cf28vPHz6dn122lgNf2rHv6SCclxKV7eRgAdkIzgnr_UiBCSudF94MBkGODDj1nWHOe4Gd4aPoT5p271u2eLOO-iaHjcm3OpmgD62ftULNuBKCPsi_C9_PdMqTnsOqQdFeqsq_3fMV3qCzGJds5nuy-5MYrvSUfmugXf1ltdv4-uCQ068Vy6I3oVicZxMxrUV3XCpgSilZUdijNqdSMvq7PUD1LnP9X-ZV8-rfC94p_oZcgdPDi82E-jqtuYZdHnD8A7FPtpI</recordid><startdate>20230601</startdate><enddate>20230601</enddate><creator>Kelfve, Susanne</creator><creator>Wastesson, Jonas W.</creator><creator>Meinow, Bettina</creator><general>SAGE Publications</general><scope>AFRWT</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>ABXSW</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>DG8</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0001-9369-1928</orcidid><orcidid>https://orcid.org/0000-0002-2059-9474</orcidid></search><sort><creationdate>20230601</creationdate><title>Educational differences in long-term care use in Sweden during the last two years of life</title><author>Kelfve, Susanne ; Wastesson, Jonas W. ; Meinow, Bettina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c515t-b33096df77e8c279c1e4b1dd6cffb0146c7df6fa9ae17b4150f2a4dff6e2a5b63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aged</topic><topic>Data Collection</topic><topic>Educational Status</topic><topic>Female</topic><topic>Home Care Services</topic><topic>Humans</topic><topic>Long-Term Care</topic><topic>Male</topic><topic>Original</topic><topic>Sweden - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kelfve, Susanne</creatorcontrib><creatorcontrib>Wastesson, Jonas W.</creatorcontrib><creatorcontrib>Meinow, Bettina</creatorcontrib><collection>SAGE Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SWEPUB Linköpings universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Linköpings universitet</collection><collection>SwePub Articles full text</collection><jtitle>Scandinavian journal of public health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kelfve, Susanne</au><au>Wastesson, Jonas W.</au><au>Meinow, Bettina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Educational differences in long-term care use in Sweden during the last two years of life</atitle><jtitle>Scandinavian journal of public health</jtitle><addtitle>Scand J Public Health</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>51</volume><issue>4</issue><spage>579</spage><epage>586</epage><pages>579-586</pages><issn>1403-4948</issn><issn>1651-1905</issn><eissn>1651-1905</eissn><abstract>Background: In old age, many people experience a period of functional decline and require long-term care. Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. Methods: We used linked register data on mortality and long-term care use, including all adults aged ⩾67 years who died in Sweden in November 2015 (N=6329). We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Men and women were analysed separately. Results: People with tertiary education died more commonly without using any long-term care compared to primary educated people (28.0% vs. 18.6%; p&lt;0.001). In the adjusted model, educational differences in the estimated number of months with long-term care disappeared among men but remained significant among women (primary educated: odds ratio=17.3 (confidence interval 16.8–17.7); tertiary educated: odds ratio=15.8 (confidence interval 14.8–16.8)). Conclusions: Older adults spend considerable time in their last two years of life with long-term care. Only minor educational differences in long-term care use remained after adjustment for cohabitation status and age at death. This suggest that Sweden’s publicly financed long-term system achieves relatively equitable use of long-term care at the end of life.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>34590503</pmid><doi>10.1177/14034948211043658</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-9369-1928</orcidid><orcidid>https://orcid.org/0000-0002-2059-9474</orcidid><oa>free_for_read</oa></addata></record>
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subjects Aged
Data Collection
Educational Status
Female
Home Care Services
Humans
Long-Term Care
Male
Original
Sweden - epidemiology
title Educational differences in long-term care use in Sweden during the last two years of life
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