Association between socioeconomic disadvantage and low-value care in acute care hospitals in Japan
Cross-sectional study
Bibliographic Data
| ID | 21467598 |
|---|---|
| Authors | So Sato (0000-0003-1265-6835, Department of Health, corresponding author), Hideo Yasunaga (0000-0002-6017-469X, University of Tokyo Health Sciences), Yuichiro Matsuo (0000-0002-8804-8628, University of Tokyo Health Sciences), Hiroki Matsui (0000-0002-6985-7083, University of Tokyo Health Sciences), Kiyohide Fushimi (0000-0002-1894-0290, Tokyo Medical and Dental University), Atsushi Miyawaki (0000-0001-6126-1464, University of Tokyo Health Sciences) |
| Year | 2026 |
| Volume | 163 |
| Pages | 105479 |
| Publication date | 2026-01-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Health Policy (JOURNAL) |
| Journal identifiers | ISSN: 0168-8510 • E-ISSN: 1872-6054 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.healthpol.2025.105479 |
| PMID | 41183420 |
| OpenAlex | W4415641310 |
| Language | EN |
| References cited | 44 |
BACKGROUND: Low-value care offers little clinical benefit and contributes to inefficient healthcare utilization. Although socioeconomic disparities in healthcare access are well documented, data on low-value care among disadvantaged inpatients remain limited. OBJECTIVE: To examine the association between neighborhood-level socioeconomic status (SES) and the proportion of low-value care services in Japanese inpatient settings using the area deprivation index (ADI) as a proxy for SES. METHODS: We conducted a cross-sectional study using a nationwide inpatient database from 920 hospitals in Japan between April 2022 and March 2023. Hospitalizations of patients aged ≥18 years receiving one of 12 selected low-value care services were included. The outcome was whether a service provided during hospitalization was classified as low-value based on established algorithms. Patients from deprived areas (top 10 % ADI) were compared with those from non-deprived areas, adjusting for patient case-mix and hospital fixed effects. RESULTS: Among 524,705 hospitalizations (42.3 % female; mean age, 69.9 ± 15.5 years), 33,271 (6.3 %) were classified as low-value care. After adjustment, patients from deprived areas had a higher proportion of low-value care than those from non-deprived areas (6.6 % vs. 6.3 %; adjusted difference, +0.2 percentage points; 95 % CI, 0.03 to 0.5; P = 0.02). Subgroup analyses showed stronger associations among patients aged ≥65, females, and those treated in non-academic hospitals. Results remained consistent after accounting for hospital fixed effects. CONCLUSIONS: Patients from disadvantaged areas are slightly more likely to receive low-value inpatient care than are those from non-disadvantaged areas. Older adults, women, and patients treated in non-academic hospitals appeared more affected
Acute care · Disadvantage · Disadvantaged · Health care · MEDLINE · Socioeconomic status · Healthcare cost, quality, practices · Healthcare Policy and Management · Primary Care and Health Outcomes
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| Citation velocity | historical |
|---|---|
| Highly cited | No |