Children's hospital admissions vary with parents' educational level.

The main conclusion of a study examining all hospital admissions of children in Norway from 2008 to 2016 is that the frequency of children's hospital admissions varies with the parents' level of education. However, there is little reason to believe that this is due to differences in the children's health, according to the researchers behind the study.

— It cannot, of course, be ruled out, but we find nothing in our data to suggest that children of parents with lower educational levels have different needs or are more frequently ill than children of parents with higher educational levels, explains statistician and researcher Frank Olsen at the Centre for Clinical Documentation and Evaluation (SKDE). He is a PhD candidate at the Institute of Community Medicine (ISM) at UiT The Arctic University of Norway.

Admitted for less serious conditions

Most children in Norway do not find themselves in a situation where they must be admitted to hospital. During the examined period, only 10.2 per cent of 1,538,189 children were admitted either once or multiple times. Frank Olsen points out, however, that the majority of children's admissions in Norwegian hospitals are for non-serious conditions. This may mean that many of the admissions are made for safety's sake rather than necessity.

— Children whose parents have lower education are admitted for less serious illnesses than children of parents with higher education.

— What could this be due to?

— It may relate to the fact that communication between healthcare personnel and parents with lower educational levels is not good enough. Perhaps the parents do not understand the healthcare personnel's language. Perhaps the healthcare personnel have less trust in the parents' assessments. That is our interpretation. But we know from previous research that well-informed patients, or parents in this case, who can also articulate themselves well have a greater chance of receiving the treatment they desire. We also know that parents with higher education are more likely to utilise higher specialised services, says Frank Olsen.

— I believe there is much to gain from involving parents and patients in an even better way and improving communication, he adds.

Geographical differences in the number of admissions

In Norway, there is political consensus that everyone should have equal access to healthcare services regardless of residence, socioeconomic status, gender, age, and ethnicity.

This study, however, shows that there are geographical differences in hospital admissions of children in Norway. Vestfold and Innlandet have the most admissions, while Oslo University Hospital and University Hospital of North Norway have the fewest.

— Is this a surprising finding?

— Both yes and no. We have previously documented that there are significant differences based on residence in connection with the health atlas for children. However, the large differences based on parents' educational levels were surprising. In all areas, there is a predominance of children with parents of lower educational levels who are admitted most frequently, explains Frank Olsen.

Treating patients with little health benefit

He believes it is important to highlight that the inequalities are not the result of deliberate actions by healthcare personnel, but rather a bias that they must be aware of.

— There may be several reasons for the geographical differences. Unequal capacity at hospitals may be an important factor. Hospitals with available capacity are more likely to treat patients with little health benefit than hospitals that are at full capacity. There is much to suggest that empty hospital beds are being filled, and not necessarily with the most needy patients, says Olsen.

Another important reason may be cultural differences between hospitals and among individual doctors. Unclear or missing guidelines can lead to differing practices. Current practice is something that is established over time, and it can be difficult to change without clear, national guidelines.

The study is part of Frank Olsen's doctoral project, which maps the population's use of publicly funded healthcare services. He is investigating, among other things, whether there are differences based on patients' residence, education, and income levels. The study has been published in the medical journal BMJ Open.