Social and policy interventions to reduce hospital admissions among socioeconomically disadvantaged groups in OECD countries with universal health care: a systematic review.

Abstract

Objectives: Socioeconomic disadvantage increases the risk of acute illnesses and injuries requiring hospital admission, some of which are avoidable. This systematic review aimed to identify the impact of interventions on hospital admissions in socioeconomically disadvantaged populations and identify knowledge gaps.

Design: Systematic review (PROSPERO, CRD42019153666).

Data sources: We searched MEDLINE (OVID), Embase (OVID), CINAHL (EBSCO), Cochrane CENTRAL (Wiley) and the Web of Knowledge platforms.

Eligibility criteria: Studies published between 1 January 2000 and 1 April 2024. We included quantitative studies that included a socioeconomically disadvantaged population, conducted studies in countries members of the Organisation for Economic Co-operation and Development (OECD) with universal healthcare and reported on hospital admission or readmissions.

Data extraction and synthesis: We assessed study quality using the Effective Public Health Practice Project tool. We summarised studies using a narrative synthesis approach and present findings using vote counting as a measure of effect.

Results: We included 20 studies of interventions targeted towards socioeconomically disadvantaged populations. Their impacts on hospitalisations of interventions, grouped under three domains-(1) population level health and social policy, (2) health and care service-based interventions and (3) integrative interventions-were mixed. Through vote counting, we found some evidence that social policy interventions targeting socioeconomically disadvantaged groups have an important impact on hospitalisations, especially those focused on improved housing and income.

Conclusions: While ongoing efforts to ensure that healthcare interventions improve the equity of access, experience and outcome are warranted, social policy interventions that address the wider determinants of health, such as housing, income and education, hold promise for controlling rates of hospital admissions in socioeconomically disadvantaged groups. This underscores the value of multi-sectoral action to reduce inequalities. Future studies should explore the long-term outcomes of interventions, particularly integrative ones, which may bring benefits in the long term but not so much in the short term.

Prospero registration number: CRD42019153666.