Lifetime healthcare expenditures across socioeconomic groups in Sweden

Abstract Background Individuals of lower socioeconomic status generally have higher healthcare expenditures than individuals of higher socioeconomic status. However, little is known about how expenditures are distributed across socioeconomic groups over a lifetime, once accounting for differences in life expectancy. This study describes how lifetime healthcare expenditures are distributed across age, sex and socioeconomic groups in Sweden while adjusting for differences in life expectancy. Methods Healthcare utilization from 2016 were linked to demographic and socioeconomic data for a random sample of individuals aged 20 and above in the four largest Swedish regions (n = 440 659). Mortality data were used to estimate income- and sex-specific survival rates. Expected lifetime healthcare expenditures were estimated by combining survival rates with mean healthcare expenditures over age, by sex, and income quintile. Results We find that expected lifetime healthcare expenditures are highest among the first (lowest) income quintile despite their evident lower life expectancy. Expected lifetime expenditures were 17.9% (16.8%) higher in the first income quintile compared to the fifth (highest) quintile for women (men). Individuals in the first income quintile had higher expected lifetime expenditures for all care categories except for primary care. Conclusion We conclude that despite a lower life expectancy, the quintile of the lowest socioeconomic status still had higher lifetime healthcare expenditures.

Note.Statistics collected from the Swedish municipality and region database Kolada (www.kolada.se).Per capita income refers to annual median income in year 2016, converted to Euros (Price year 2021, 1 € = 10,146 SEK).Per capita HCE refers to healthcare expenditures in year 2016, defined as the total net costs of healthcare, including dental care and prescribed drugs, divided by the number of inhabitants, converted to Euros.Care need index is an index constructed by socioeconomic parameters to defined an area's risk for ill-health, a value of 1.00 implies higher risk for ill-health compared to the nation and vice versa.Note.Education level is operationalized as the highest obtained educational degree starting with lower-secondary education (compulsory nine years or less) upper-secondary education (three years or less), university (two years or higher).Price year 2021, 1 € = 10.146SEK.

Table A1
Descriptive statistics of Swedish regions

Table A3
Characteristics of the study population.

Table A4
Mean annual expenditures (€) by care level, age groups, and sex.

Table A6
Estimated difference between income quintiles, in annual healthcare expenditures (€) Estimated by fractional polynomial regression with a fourth-degree fractional polynomial of age, regressing the expected cost on age and income quintile.SEGsocioeconomic group defined by income quintiles.The fifth (highest) income quintile was used as the reference.Price year 2021, 1 € = 10,146 SEK.* p < 0.05, ** p < 0.01, *** p < 0.001

Table A7
Lifetime healthcare expenditures (€) by care category, income quintile, and sex, using income-and sex-specific mortality rates.Expected lifetime healthcare expenditures calculated assuming the same overall mortality rate for all women and men Figure A2 Education level -Lifetime healthcare expenditures by care level, sex, and education level Note.Educational level divided into three groups starting with low (lower secondary), middle (upper secondary), and ending with high (post-secondary).Figure A3 Education level -Mean annual healthcare expenditures over age, by sex and educational level.Note.Educational level divided into three groups starting with low (lower secondary), middle (upper secondary), and ending with high (post-secondary).Figure A4 Income deciles -Mean annual healthcare expenditures over age, by sex and income group Figure A5 Income deciles -Lifetime healthcare expenditures by care level, sex, and income group Figure A6 Retrospective DRG-weights -Mean annual expenditures (€) over age, by care category and sex Figure A7 Retrospective DRG-weights -Lifetime healthcare expenditures by care level, sex, and income group