title: Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993-2006.
abstract: OBJECTIVE
  The aim of this study was to analyse the trends and socio-economic inequalities in the use of health care services in Spain between 1993 and 2006.
  
  
  METHODS
  A study of trends was performed using data from six Spanish National Health Surveys (1993, 1995, 1997, 2001, 2003 and 2006). Sample sizes were 21,061; 6,396; 6,396; 21,066; 21,650 and 29,478, respectively. The following dependent variables were analysed: having visited a general practitioner (GP) or specialist in the previous 2 weeks, having visited a dentist within the previous 3 months and having visited a gynaecologist, having used the emergency services or having been hospitalised in the previous year. The main independent variable was social class, classified as manual or non-manual occupation. For each service, age-standardised proportions of use were calculated by survey year, sex and social class, and indices of relative (RII) and absolute (SII) inequality were computed. Trend tests were applied.
  
  
  RESULTS
  An increase in the proportion of use was observed for all services, particularly emergency services. Individuals from manual classes were more likely to visit the GP and emergency services than those from non-manual classes. Conversely, those from non-manual classes were more likely to use specialised services. This trend was most notable for dentist visits. Social inequalities did not change significantly during the study period.
  
  
  CONCLUSIONS
  Despite the increase in the use of health care services, the relationship between social class and the use of these services has remained stable throughout the study period. Achieving equity in the use of specialised care services is still a challenge for universal health care systems.
authors.affiliation: CIBER de Epidemiología y Salut Pública (CIBERESP), Madrid, Spain. lpalenci@aspb.cat
authors.forename: Laia
authors.initials: L
authors.lastname: Palència
authors.forename: Albert
authors.initials: A
authors.lastname: Espelt
authors.forename: Maica
authors.initials: M
authors.lastname: Rodríguez-Sanz
authors.forename: Katia B
authors.initials: KB
authors.lastname: Rocha
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Pasarín
authors.forename: Carme
authors.initials: C
authors.lastname: Borrell
mesh_terms: D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006302:Health Services Research; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012923:Social Class; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology
references.citation: Gac Sanit. 2006 Mar-Apr;20(2):91-9
references.pmid: 16753084
references.citation: Soc Sci Med. 1997 Mar;44(6):757-71
references.pmid: 9080560
references.citation: Eur J Public Health. 2007 Apr;17(2):186-92
references.pmid: 16751633
references.citation: Soc Sci Med. 2001 Nov;53(9):1149-62
references.pmid: 11556606
references.citation: Prev Med. 2000 Dec;31(6):691-701
references.pmid: 11133336
references.citation: Int J Health Serv. 2010;40(3):525-42
references.pmid: 20799674
references.citation: Med Clin (Barc). 2011 Dec;137 Suppl 2:60-5
references.pmid: 22310366
references.citation: Rev Esp Salud Publica. 2001 Mar-Apr;75(2):115-27
references.pmid: 11400422
references.citation: CMAJ. 2006 Jan 17;174(2):177-83
references.pmid: 16415462
references.citation: Int J Health Serv. 2007;37(4):693-709
references.pmid: 18072316
references.citation: Scand J Public Health. 2009 Mar;37(2):131-8
references.pmid: 19124597
references.citation: Milbank Q. 2005;83(3):457-502
references.pmid: 16202000
references.citation: Health Econ. 2004 Jul;13(7):629-47
references.pmid: 15259043
references.citation: Lancet. 2005 Mar 19-25;365(9464):1099-104
references.pmid: 15781105
references.citation: Med Clin (Barc). 2003 May 17;120(18):711-6
references.pmid: 12781099
references.citation: Gac Sanit. 2004 May;18 Suppl 1:102-11
references.pmid: 15171865
references.citation: Gac Sanit. 2006 Mar-Apr;20(2):99-100
references.pmid: 16753085
references.citation: Int J Health Serv. 2007;37(2):353-61
references.pmid: 17665728
references.citation: Annu Rev Public Health. 1997;18:341-78
references.pmid: 9143723
references.citation: Int J Epidemiol. 2010 Jun;39(3):757-65
references.pmid: 20176587
references.citation: Am J Epidemiol. 2004 Apr 1;159(7):702-6
references.pmid: 15033648
references.citation: BMC Health Serv Res. 2008 Sep 14;8:183
references.pmid: 18789164
references.citation: Health Econ. 2005 Sep;14(Suppl 1):S221-35
references.pmid: 16161193
references.citation: Gac Sanit. 2002 Sep-Oct;16(5):376-84
references.pmid: 12372182
references.citation: Gac Sanit. 2012 Mar-Apr;26(2):182-9
references.pmid: 22112713
references.citation: Health Policy. 2002 Nov;62(2):117-29
references.pmid: 12354407
references.citation: Aten Primaria. 2007 Jul;39(7):339-46
references.pmid: 17669316
references.citation: Am J Public Health. 2006 Jul;96(7):1300-7
references.pmid: 16735628
references.citation: Int J Health Serv. 2007;37(2):363-78
references.pmid: 17665729
references.citation: Int J Health Serv. 2007;37(1):89-109
references.pmid: 17436987
references.citation: BMJ. 2009 Sep 03;339:b3264
references.pmid: 19729415
references.citation: Health Policy. 1997 Aug;41(2):121-37
references.pmid: 10169298
references.citation: Soc Sci Med. 2007 Jul;65(2):367-76
references.pmid: 17544192
references.citation: Ann Fam Med. 2009 Sep-Oct;7(5):396-405
references.pmid: 19752467