Inequalities in health and health service utilisation among reproductive age women in St. Petersburg, Russia: a cross-sectional study.
BACKGROUND
Russian society has faced dramatic changes in terms of social stratification since the collapse of the Soviet Union. During this time, extensive reforms have taken place in the organisation of health services, including the development of the private sector. Previous studies in Russia have shown a wide gap in mortality between socioeconomic groups. There are just a few studies on health service utilisation in post-Soviet Russia and data on inequality of health service use are limited. The aim of the present study was to analyse health (self-rated health and self-reported chronic diseases) and health care utilisation patterns by socioeconomic status (SES) among reproductive age women in St. Petersburg.


METHODS
The questionnaire survey was conducted in 2004 (n = 1147), with a response rate of 67%. Education and income were used as dimensions of SES. The association between SES and health and use of health services was assessed by logistic regression, adjusting for age.


RESULTS
As expected low SES was associated with poor self-rated health (education: OR = 1.48; personal income: OR = 1.42: family income: OR = 2.31). University education was associated with use of a wider range of outpatient medical services and increased use of the following examinations: Pap smear (age-adjusted OR = 2.06), gynaecological examinations (age-adjusted OR = 1.62) and mammography among older (more than 40 years) women (age-adjusted OR = 1.98). Personal income had similar correlations, but family income was related only to the use of mammography among older women.


CONCLUSIONS
Our study suggests a considerable inequality in health and utilisation of preventive health service among reproductive age women. Therefore, further studies are needed to identify barriers to health promotion resources.
St. Petersburg Medical Academy of Postgraduate Studies, 193015 Kirochnaja ul, 41, St. Petersburg, Russia. tanyadks@hotmail.com
Tatiana
T
Dubikaytis
Meri
M
Larivaara
Olga
O
Kuznetsova
Elina
E
Hemminki
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D004522:Educational Status; D005195:Family Relations; D005260:Female; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D012098:Reproduction; D018570:Risk Assessment; D012426:Russia; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000706:statistics & numerical data; D016387:Women's Health; D014932:Women's Health Services / Q000706:statistics & numerical data*; D055815:Young Adult