Sociodemographic and Health Characteristics, Rather Than Primary Care Supply, are Major Drivers of Geographic Variation in Preventable Hospitalizations in Australia

Michael O Falster, Louisa R Jorm, Kirsty A Douglas, Fiona M Blyth, Robert F Elliott, Alastair H Leyland

Research output: Contribution to journalArticlepeer-review

66 Citations (Scopus)
9 Downloads (Pure)


BACKGROUND: Geographic rates of preventable hospitalization are used internationally as an indicator of accessibility and quality of primary care. Much research has correlated the indicator with the supply of primary care services, yet multiple other factors may influence these admissions.

OBJECTIVE: To quantify the relative contributions of the supply of general practitioners (GPs) and personal sociodemographic and health characteristics, to geographic variation in preventable hospitalization.

METHODS: Self-reported questionnaire data for 267,091 participants in the 45 and Up Study, Australia, were linked with administrative hospital data to identify preventable hospitalizations. Multilevel Poisson models, with participants clustered in their geographic area of residence, were used to explore factors that explain geographic variation in hospitalization.

RESULTS: GP supply, measured as full-time workload equivalents, was not a significant predictor of preventable hospitalization, and explained only a small amount (2.9%) of the geographic variation in hospitalization rates. Conversely, more than one-third (36.9%) of variation was driven by the sociodemographic composition, health, and behaviors of the population. These personal characteristics explained a greater amount of the variation for chronic conditions (37.5%) than acute (15.5%) or vaccine-preventable conditions (2.4%).

CONCLUSIONS: Personal sociodemographic and health characteristics, rather than GP supply, are major drivers of preventable hospitalization. Their contribution varies according to condition, and if used for performance comparison purposes, geographic rates of preventable hospitalization should be reported according to individual condition or potential pathways for intervention.

Original languageEnglish
Pages (from-to)436-445
Number of pages10
JournalMedical Care
Issue number5
Publication statusPublished - May 2015

Bibliographical note

ACKNOWLEDGMENTS: The authors thank the many thousands of people participating in the 45 and Up Study. The authors also thank the Sax Institute, the NSW Ministry of Health, and the NSW Register of Births, Deaths, and Marriages for allowing access to the data, and the Centre for Health Record Linkage for conducting the probabilistic linkage of records.


  • : preventable hospitalization
  • multilevel modelling
  • primary care


Dive into the research topics of 'Sociodemographic and Health Characteristics, Rather Than Primary Care Supply, are Major Drivers of Geographic Variation in Preventable Hospitalizations in Australia'. Together they form a unique fingerprint.

Cite this