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Educational differences in long-term care use in Sweden during the last two years of life
Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden; Stockholm Univ, Sweden.ORCID iD: 0000-0001-9369-1928
Karolinska Inst, Sweden; Stockholm Univ, Sweden; Karolinska Inst, Sweden.
Karolinska Inst, Sweden; Stockholm Univ, Sweden; Stockholm Gerontol Res Ctr, Sweden.
2023 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 51, no 4, p. 579-586, article id 14034948211043658Article in journal (Refereed) Published
Abstract [en]

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<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 Swedens publicly financed long-term system achieves relatively equitable use of long-term care at the end of life.

Place, publisher, year, edition, pages
Sage Publications, 2023. Vol. 51, no 4, p. 579-586, article id 14034948211043658
Keywords [en]
Elder care; level of education; sex; residential care; home-help services; register data; end of life
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:liu:diva-180378DOI: 10.1177/14034948211043658ISI: 000704038300001PubMedID: 34590503OAI: oai:DiVA.org:liu-180378DiVA, id: diva2:1603960
Note

Funding Agencies|Swedish Research Council for Health, Working Life and WelfareSwedish Research CouncilSwedish Research Council for Health Working Life & Welfare (Forte) [2016-00197]; Swedish Research CouncilSwedish Research CouncilEuropean Commission [2016-01072_6]

Available from: 2021-10-18 Created: 2021-10-18 Last updated: 2023-12-07Bibliographically approved

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Kelfve, Susanne

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