THE INFLUENCE OF SOCIOECONOMIC-STATUS ON CHANGE IN HEALTH-STATUS AFTER HOSPITALIZATION

We reviewed patients' hospital records and surveyed patients after hos pital discharge to determine whether the experience of being hospitali zed differentially affected the health status of persons with differen t socioeconomic backgrounds (as measured by income level and education level) and to determine whether the association between socioeconomic status (SES) and change in health status varied depending upon the re ason for hospital admission. We studied patients admitted to six unive rsity-affiliated teaching hospitals in Massachusetts and California fo r chest pain (N = 797) and surgery (N = 1165). We compared the health status scores of patients for a variety of outcomes: basic activities of daily living, instrumental activities of daily living, social activ ities, mental well-being, work performance and housework performance. Lower-SES patients entered the hospital with worse health status than higher-SES patients. Change in health status, statistically adjusted f or case-mix, varied by reason for admission. Patients with chest pain generally reported either no improvement or a decline in functioning w ith the amount of decline equivalent for low- and high-SES patients. S urgical patients reported improvement in functioning following hospita lization. For several measures, lower-income surgical patients reporte d greater improvement than did higher-income patients, but still did n ot reach the same level of health status as higher-income patients.