000132298 001__ 132298 000132298 005__ 20240301161208.0 000132298 0247_ $$2doi$$a10.1016/j.socscimed.2024.116589 000132298 0248_ $$2sideral$$a137463 000132298 037__ $$aART-2024-137463 000132298 041__ $$aeng 000132298 100__ $$aGustafsson, Per E. 000132298 245__ $$aA novel application of interrupted time series analysis to identify the impact of a primary health care reform on intersectional inequities in avoidable hospitalizations in the adult Swedish population 000132298 260__ $$c2024 000132298 5060_ $$aAccess copy available to the general public$$fUnrestricted 000132298 5203_ $$aPrimary health care (PHC) systems are a crucial instrument for achieving equitable population health, but there is little evidence of how PHC reforms impact equities in population health. In 2010, Sweden implemented a reform that promoted marketization and privatization of PHC. The present study uses a novel integration of intersectionality-informed and evaluative epidemiological analytical frameworks to disentangle the impact of the 2010 Swedish PHC reform on intersectional inequities in avoidable hospitalizations. The study population comprised the total Swedish population aged 18–85 years across 2001–2017, in total 129 million annual observations, for whom register data on sociodemographics and hospitalizations due to ambulatory care sensitive conditions were retrieved. Multilevel Analysis of Individual Heterogeneity and Discriminatory Analyses (MAIHDA) were run for the pre-reform (2001–2009) and post-reform (2010–2017) periods to provide a mapping of inequities. In addition, random effects estimates reflecting the discriminatory accuracy of intersectional strata were extracted from a series MAIHDAs run per year 2001–2017. The estimates were re-analyzed by Interrupted Time Series Analysis (ITSA), in order to identify the impact of the reform on measures of intersectional inequity in avoidable hospitalizations. The results point to a complex reconfiguration of social inequities following the reform. While the post-reform period showed a reduction in overall rates of avoidable hospitalizations and in age disparities, socioeconomic inequities in avoidable hospitalizations, as well as the importance of interactions between complex social positions, both increased. Socioeconomically disadvantaged groups born in the Nordic countries seem to have benefited the least from the reform. The study supports a greater attention to the potentially complex consequences that health reforms can have on inequities in health and health care, which may not be immediate apparent in conventional evaluations of either population-average outcomes, or by simple evaluations of equity impacts. Methodological approaches for evaluation of complex inequity impacts need further development. 000132298 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/ 000132298 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion 000132298 700__ $$aFonseca-Rodríguez, Osvaldo 000132298 700__ $$0(orcid)0000-0002-5064-3763$$aCastel Feced, Sara 000132298 700__ $$aSan Sebastián, Miguel 000132298 700__ $$aBastos, João Luiz 000132298 700__ $$aMosquera, Paola A. 000132298 773__ $$g343 (2024), 116589 [10 pp.]$$pSoc. sci. med.$$tSOCIAL SCIENCE & MEDICINE$$x0277-9536 000132298 8564_ $$s6250852$$uhttps://zaguan.unizar.es/record/132298/files/texto_completo.pdf$$yVersión publicada 000132298 8564_ $$s2526563$$uhttps://zaguan.unizar.es/record/132298/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000132298 909CO $$ooai:zaguan.unizar.es:132298$$particulos$$pdriver 000132298 951__ $$a2024-03-01-14:54:12 000132298 980__ $$aARTICLE