Self-perceived health status and inequalities in use of health services in Spain.
BACKGROUND
Socioeconomic differences have been described among the Spanish population. The purpose of this study was to investigate whether these variations are associated with differences in the use of health services between socioeconomic groups in Spain, taking into account self-perceived health as a measure of need.


METHODS
Data were obtained from the 1987 Spanish National Health Survey. Socioeconomic position was measured by educational level and household income. Health care use was measured in two ways: prevalence of having consulted a doctor and of hospitalization over a defined period of time. Logistic regression models were used to analyse the relationship of interest.


RESULTS
After adjustment for age, an inverse association was seen between education and both consultation with a doctor and hospitalization. A very different picture emerged when the association between socioeconomic position and probability of health service use was examined according to level of self-perceived health. Among those with poor or very poor health, people in higher educational groups showed the greatest probability of consulting a doctor (odds ratio [OR] = 1.41, 95% confidence interval [CI] : 0.89-2.23) or of being hospitalized (OR = 1.79, 95% CI : 1.09-2.93) compared to those in the lower educational groups. The corresponding OR for household income were 1.02 (95% CI : 0.74-1.42) for consultation with a doctor and 1.67 (95% CI : 1.15-2.44) for hospitalization. These finding were broadly similar for men and women.


CONCLUSIONS
There is a socioeconomic variation in the pattern of use of health services in Spain in the sense that among those with poor self-perceived health, the more privileged have higher levels of health services use than others.
Fernández de la Hoz
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Sección de Epidemiología, Delegación Provincial de Sanidad, Subida dela Granja 10, 45071 Toledo, Spain.
Leon
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DA
D000293:Adolescent; D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D013030:Spain