title: Inequalities in morbidity and consulting behaviour for socially vulnerable groups.
abstract: BACKGROUND
  The focus of health policy on improving health and reducing inequality for socially vulnerable groups.
  
  
  OBJECTIVE
  To examine self-report of condition-specific morbidity and consultation with the general practitioner (GP) for socially vulnerable groups.
  
  
  METHODS
  Cross-sectional survey using a modified version of the General Practitioner Assessment Survey (GPAS).
  
  
  METHODS
  Ten general practices in each of six health authorities.
  
  
  METHODS
  A random sample of 200 patients was selected from each practice. The questionnaire elicited information about experience of specific acute and chronic conditions and whether the GP had been consulted. Four sub-samples were selected from the 4493 registered patients who responded to the self-completion questionnaire. They were lone mothers (n = 160), elderly living alone (n = 417), the unemployed (n = 100), and members of ethnic minority groups (n = 316).
  
  
  RESULTS
  Logistic regression analyses showed that, after adjustment for age, sex, smoking, and housing tenure, only lone motherhood and ethnic minority group status were consistently and independently associated with poorer health outcomes. Lone motherhood was associated with a higher likelihood of anxiety (odds ratio [OR] = 2.03, 95% confidence interval [CI] = 1.34 to 3.08) and sleep problems (OR = 1.83, 95% CI = 1.18 to 2.83) and ethnic minority group status with a higher likelihood of depression (OR = 2.02, 95% CI = 1.34 to 3.04), diabetes (OR = 4.03, 95% CI = 2.54 to 6.39, migraine (OR = 1.72, 95% CI = 1.26 to 2.35), and minor respiratory symptoms (OR = 1.75, 95% CI = 1.33 to 2.29). Ethnic minority group status was the only source of social vulnerability that was independently associated with a higher likelihood of GP consultation, particularly for episodes of illness such as backache (OR = 3.28, 95% CI = 2.06 to 5.21), indigestion (OR = 2.94, 95% CI = 1.53 to 5.65), migraine (OR = 3.22, 95% CI = 1.75 to 5.93), minor respiratory symptoms (OR = 3.53, 95% CI = 2.26 to 5.50) and sleep problems (OR = 4.72, 95% CI = 2.56 to 8.71).
  
  
  CONCLUSIONS
  Social vulnerability can be a risk factor for poorer health, but this is dependent on the source of vulnerability and is condition-specific. No association was found between inequity in the utilisation of primary care and social vulnerability. The propensity for members of ethnic minority groups to consult more than white people, particularly for acute conditions, requires further exploration.
authors.affiliation: National Primary Care Research and Development Centre, Manchester. d.baker@man.ac.uk
authors.forename: Deborah
authors.initials: D
authors.lastname: Baker
authors.forename: Nicola
authors.initials: N
authors.lastname: Mead
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility / Q000592:standards; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D015406:Single Parent; D012959:Socioeconomic Factors; D014478:Unemployment; D006113:United Kingdom