Original approach to the individual characteristics associated with forgone healthcare: a study in underprivileged areas, Paris region, France, 2001-2003.
BACKGROUND
The social inequalities in health have endured or even worsened comparatively throughout different social groups since the 1990s. Our objective was to identify the individual characteristics (socio-economic status, living conditions, individuals' social integration, health beliefs, expectations and representation and psychological characteristics) statistically associated with the fact of stating (or not) that healthcare had been forgone because of cost.


METHODS
In this cross-sectional, multi-centre study we randomly selected a study sample from five underprivileged areas in the Paris region. A multiple logistic regression model was used to calculate the odds ratios (OR) and 95% confidence interval (CI). The validity of the model was assessed by goodness-of-fit tests (Pearson and deviance) and by the study of 100 bootstrap samples.


RESULTS
After making adjustments for numerous individual socio-economic and health characteristics, we observed a higher occurrence of reported forgone healthcare among people who have had financial worries during adulthood [ORyes/no=5.47 (1.44-20.75)], a life-course experience of physical, sexual or psychological abuse [ORyes/no=2.86 (1.40-5.84)]; who have experienced childhood difficulties [OR1/never difficulties=5.28 (1.81-15.39), OR2-4/never=7.62 (2.69-21.57), OR>4/never=8.57 (2.39-30.80)]; who have expressed a low degree of sickness orientation [OR(low/high)=2.62 (1.33-5.14)], a high worry/concern about health [ORhigh/low=2.71 (1.33-5.50)] and a low self-esteem [ORmedium/high=8.28 (1.44-47.64), ORlow/high=16.44 (2.81-96.24)].


CONCLUSIONS
Aside from purely financial hurdles, other factors play a role in the non-use of healthcare services. Health policies mainly promoting equal financial access to healthcare have little chance of abating health inequalities.
Fabienne
F
Bazin
Isabelle
I
Parizot
Pierre
P
Chauvin
D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D005102:Health Expenditures; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011204:Poverty Areas; D012959:Socioeconomic Factors; D016312:Treatment Refusal / Q000523:psychology*