title: Regional inequalities in self-rated health and disability in younger and older generations in Turkey: the contribution of wealth and education.
abstract: BACKGROUND
  In Turkey, large regional inequalities were found in maternal and child health. Yet, evidence on regional inequalities in adult health in Turkey remains fragmentary. This study aims to assess regional and rural/urban inequalities in the prevalence of poor self-rated health and in disability among adult populations in Turkey, and to measure the contribution of education and wealth of individual residents. The central hypothesis was that geographical inequalities in adult health exist even when the effect of education and wealth were taken into account.
  
  
  METHODS
  We analyzed data of the 2002 World Health Survey for Turkey on 10791 adults aged 20 years and over. We measured respondents' rating of their own general health and the prevalence of five types of physical disability. Logistic regression was used to estimate how much these two health outcomes varied according to urban/rural place of residence, region, education level and household wealth. We stratified the analyses by gender and age (‹50 and ≥50 years).
  
  
  RESULTS
  Both health outcomes were strongly associated with educational level (especially for older age group) and with household wealth (especially for younger age group). Both health outcomes also varied according to region and rural/urban place of residence. Higher prevalence rates were observed in the East region (compared to West) with odd ratios varying between 1.40-2.76. After controlling for education and wealth, urban/rural differences in health disappeared, while regional differences were observed only among older women. The prevalence of poor self-rated health was higher for older women in the Middle (OR = 1.69), Black Sea (OR = 1.53) and East (OR = 2.06) regions.
  
  
  CONCLUSIONS
  In Turkey, substantial geographical inequalities in self-reported adult health do exist, but can mostly be explained by differences in socioeconomic characteristics of residents. The regional disadvantage of older women in the East, Middle and Black Sea may have resulted from life-long exposure to gender discrimination under a patriarchal ideology. Yet, not geographic inequalities, but the more fundamental socioeconomic inequalities, are of key public health concern, also in Turkey.
authors.affiliation: Department of Public Health, Ege University School of Medicine, Bornova, Izmir, Turkey. isil.ergin@ege.edu.tr.
authors.forename: Isil
authors.initials: I
authors.lastname: Ergin
authors.affiliation: Department of Public Health, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands. a.kunst@amc.uva.nl.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
mesh_terms: D000328:Adult; D000368:Aged; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D006262:Health; D006304:Health Status; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D057566:Self Report; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult