ArticleInternational journal for equity in health2025
Decomposing socioeconomic differences in self-rated health and healthcare expenditure by chronic conditions and social determinants.
Article in International journal for equity in health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Workplace social capital and self-rated health among nursery school teachers in Japan: a nationwide cross-sectional study.Frontiers in public health · 2026Article
- Can sports consumption cities reduce residents' medical expenditures? Evidence from China.Frontiers in public health · 2026Article
- Decomposing Medicare total, Part D, and Part B drug payments among people with Alzheimer's disease and related diseases.Health affairs scholar · 2025Article
- Analysis of temporal and spatial changes in the global burden of hypertensive heart disease based on data from the Global Burden of Disease study database and future projections: 1990-2046.Frontiers in cardiovascular medicine · 2025Article
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Authors and funding
6 authors.
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Abstract
backgroundLower socioeconomic status is associated with lower self-rated health and higher healthcare expenditure. This study identifies which chronic conditions and social determinants contribute most to socioeconomic differences in self-rated health and healthcare expenditure.
methodsRegistry and survey data combining 3 socioeconomic indicators (income, education, and financial welfare), 26 social determinants, 20 chronic conditions, age, sex, self-rated health, and healthcare expenditure for 135,183 Dutch individuals aged 25-65, were linked at individual level. Oaxaca-Blinder decomposition analyses were conducted to quantify the relative contributions of chronic conditions and social determinants to socioeconomic differences in self-rated health and healthcare expenditure.
resultsPoorer self-rated health and higher healthcare expenditure among lower income groups were partly attributable to a higher prevalence of chronic conditions (33% and 70%, respectively). Acid-related disorders, cardiovascular diseases and psychological disorders contributed most to both differences in self-rated health and healthcare expenditure. Social determinants almost completely accounted for income differences in self-rated health. Social determinants explained more than the observed difference in healthcare expenditure between income groups, suggesting that, when adjusted for social determinants, lower income groups would have lower healthcare expenditure than higher income groups. Including both chronic conditions and social determinants in a single decomposition indicated that income security & social protection (28%), social & human capital (26%), and chronic conditions (23%) were equally important to income differences in self-rated health. For healthcare expenditure, chronic conditions and social determinants each accounted for approximately half of the socioeconomic differences.
conclusionsSocial determinants outside the healthcare sector accounted for almost all of the socioeconomic differences in self-rated health. This highlights the need for integrated policies across multiple domains, such as the social, economic and healthcare sector, to reduce avoidable health inequalities. Given that socioeconomic differences in healthcare expenditure were primarily associated with chronic conditions, prioritizing prevention of chronic conditions among lower socioeconomic groups can potentially reduce healthcare spending within this group and improve the healthcare system's sustainability and affordability.
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