Invisible social barriers refer to structures that exist to keep certain segments of the population from accessing desired services or goods. These barriers include socio-economic status, racial identity, and geographic location. McCartney, Hart, and Watt conducted a study in 2013 that examined the effects of gender and socio-economic status on emergent and non-emergent hospital admissions in Scotland.1 Researchers hoped to obtain a baseline measure of the proportionality of hospital admissions to need, as poor people in general tend to have more health problems than the affluent.

Researchers used data from 14,956 women and men collected between 1972 and 1976 including smoking habit, diabetes, bronchitis, angina, and occupation. Participants were subjected to a physical examination and blood pressure, a blood sample, height and weight, and an ECG were collected. Information about participants’ death was collected from the National Health Service Central Register, and computerized linkages were made with hospital records systems. Hospital admissions and length of stay were categorized according to reason for admission: cardiovascular disease, coronary heart disease, stroke, respiratory diseases, digestive diseases, and cancers. Mental health admission information was also collected and categorized into depression/anxiety, psychoses, drug/alcohol dependence, and Alzheimer’s disease and dementia. Figure 1 shows the gradient in emergency and non-emergency admissions from social classes I and II (affluent) to social classes IV and V (impoverished). Researchers did find that there was substantial social patterning for overall admissions to the hospital for mental health conditions, particularly for psychosis, Alzheimer’s disease, and drug- and alcohol-related admissions in men. Researchers also noted that there was a declining rate ratio for non-emergency hospital admissions from affluent to poor social classes in terms of mental health conditions.

Figure 1. Patterning of emergency and non-emergency admissions to hospital by social class.

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