Social inequalities in health- do they diminish with age? Revisiting the question in Sweden 1999

International Journal for Equity in Health

Thor Lithman³  Anders Norlund¹  Anders Beckman⁴  John Lynch²  Ulf-G Gerdtham⁴  Juan Merlo⁴ 

[1] SBU – The Swedish Council on Technology Assessment in Health Care;Department of Epidemiology, Center for Social Epidemiology and Population Health, and Institute for Social Research, University of Michigan, Ann Arbor, USA;Regional Office, Skåne County Council, Lund, Sweden;Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden

关键词: social medicine;    elderly;    health care utilisation;    mortality;    Income;   

Others  :  1147981
DOI  :  10.1186/1475-9276-2-2

 received in 2002-09-22, accepted in 2003-03-11,  发布年份 2003

【 摘 要 】

Background

Individuals with low income have poorer health and should, therefore, have higher health expenditure than people with high income particularly in countries with a universal health care system. However, it has been discussed if social inequities in health diminish with age and we, hence, aimed to analyse this question.

Methods

We performed an age stratified cross-sectional analysis using averages, logistic and linear regression modelling of health care contacts, health care expenditures and mortality in relation to individual income in five groups by quintiles. The population consisted of all the 249,855 men aged 40 to 80 years living in the county of Skåne, Sweden during 1999.

Results

For working-age people (40-59 year old) we find a clear socioeconomic gradient with increasing probability of health care contact, relative expenditure and mortality as income decreased. The point estimations for 1st (highest)-2nd-3rd-4th and 5th (lowest) income groups were: (1.00-1.13-1.21-1.42 and 1.15), (1.00-1.16-1.29-1.69 and 1.89) and (1.00-1.35-1.44-2.82 and 4.12) for health care contact, relative expenditure and mortality respectively. However, in the elderly (75-80 year old) these point estimates were (1.00-0.83-0.59-0.61 and 0.39), (1.00-1.04-1.05-1.02 and 0.96) and (1.00-1.06-1.30-1.33 and 1.49).

Conclusions

As expected among working-age individuals, lower income was associated with higher health care contact, relative expenditure and mortality. However, the existence of opposite socioeconomic gradients in health care utilisation and mortality in the elderly suggests that factors related to a high income might condition allocation of resources, or that current medical care is ineffective to treat determinants of income differences in mortality occurring earlier in the lifecourse.

【 授权许可】

   
2003 Merlo et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 图 表 】

Figure 1.

【 参考文献 】

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