Changes in the sociodemographic composition of the lowest socioeconomic group over time, 1987-2001.
BACKGROUND
When comparing health differences of groups with equal socioeconomic status (SES) over time, the sociodemographic composition of such a SES group is considered to be constant. However, when the periods are sufficiently spaced in time, sociodemographic changes may have occurred. The aim of this study is to examine in which respects the sociodemographic composition of lowest SES group changed between 1987 and 2001.


METHODS
Our data were derived from the first and second Dutch National Survey of General Practice conducted in 1987 and 2001. In 1987 sociodemographic data from all listed patients (N = 334,007) were obtained by filling out a registration form at the practice (response 78.3%, 261,691 persons), in 2001 these data from all listed patients (385,461) were obtained by postal survey (response 76.9%, 296,243 persons). Participants were primarily classified according to their occupation into three SES groups: lowest, middle and highest.


RESULTS
In comparison with 1987, the lowest SES group decreased in relative size from 34.9% to 29.5%. Within this smaller SES group, the relative contribution of persons with a higher education more than doubled for females and doubled for males. This indicates that the relation between educational level and occupation was less firmly anchored in 2001 than in 1987. The relative proportion of some disadvantaged groups (divorced, unemployed) increased in the lowest SES group, but the size of this effect was smaller than the increase from higher education. Young people (0-24 years) were proportionally less often represented in the lowest SES group. Non-Western immigrants contributed in 2001 proportionally less to the lowest SES group than in 1987, because of an intergenerational upward mobility of the second generation.


CONCLUSIONS
On balance, the changes in the composition did not result in an accumulation of disadvantaged groups in the lowest SES group. On the contrary, the influx of people with higher educational qualifications between 1987 and 2001 could result in better health outcomes and health perspectives of the lowest SES group.
Bongers
Frans J M
FJ
Netherlands Institute for Health Services Research NIVEL, Utrecht, The Netherlands. F.Bongers@nivel.nl
Deunk
Linelle E N
LE
Schellevis
Francois G
FG
van den Hoogen
Henk J M
HJ
van der Zee
Jouke
J
van den Bosch
Wil J H M
WJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003710:Demography; D004522:Educational Status; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011203:Poverty / Q000208:ethnology / Q000706:statistics & numerical data* / Q000639:trends; D012923:Social Class; D013997:Time Factors; D035862:Vulnerable Populations / Q000208:ethnology / Q000706:statistics & numerical data*