Beyond clinical need: socioeconomic inequalities in access to hospital at home among older adults

Background As Hospital at Home models expand to meet the needs of older adults with complex care needs, concerns persist that access may be shaped by socioeconomic (SE) factors. This study examined SE disparities in admission to two Comprehensive Geriatric Assessment (CGA)-based care models- HaH versus Bed-Based intermediate care Unit (BBU) - among older adults in Barcelona, Spain. Methods We analysed data from a retrospective cohort of adults aged≥65 years admitted to BBU or HaH at Parc Sanitari Pere Virgili, Spain, between 2018 and 2023. Individual and small area-level SE variables were collected from linked administrative health records. We used mixed models to estimate the effect of SE variables on the odds of HaH admission. Results HaH patients were younger, less morbid, and more socioeconomically advantaged than BBU patients; after adjustment, higher income (OR 1.68, 95% CI 1.45–1.96) was associated with increased odds of HaH admission, while area-level explained≈20% of variability in HaH admission, with SE effects varying widely across small areas. Conclusions Access to HaH is associated with individual and area-level SE context independently of demographic and clinical factors, highlighting the need to address social barriers to ensure equitable delivery of homebased hospital care for older adults.