title: Is geographical distance a barrier in the use of public primary health services among rural and urban young adults? Experience from Northern Finland.
abstract: OBJECTIVE
  To study the role of distance in public primary health service use in rural and urban local residential areas (1 km² grids) among the young adults of the Northern Finland Birth Cohort 1966 (N = 4503).
  
  
  METHODS
  Cross-sectional study of a cohort born in Northern Finland in 1966.
  
  
  METHODS
  Use of local health centres was surveyed by postal questionnaire in 1997, and distance from study subjects' home to health centre was calculated along road network. The crude and adjusted incidence rate ratios (IRR) and their 95% confidence intervals were calculated for distance, predisposing and illness-level variables. Distance-related health inequity indices were calculated.
  
  
  RESULTS
  The IRRs indicated 1.5-fold higher rate of health centre visits among subjects living farther than 10 km compared to subjects living within 2 km from health centre in urban areas. In rural areas, IRRs indicated no significant association with distance and health centre use. No distance-related inequity in the use of health centre services was found.
  
  
  CONCLUSIONS
  Distance does not seem to be major barrier in health service use among these 31-year old adults. However, closer study of some groups, such as the rural unemployed, might be valuable.
authors.affiliation: Department of Geography, University of Oulu, PO Box 3000, 90014, Oulu, Finland; Center for Life Course Epidemiology and Systems Medicine, University of Oulu, PO Box 5000, 90014, Oulu, Finland. Electronic address: tiina.lankila@oulu.fi.
authors.forename: T
authors.initials: T
authors.lastname: Lankila
authors.affiliation: Center for Environmental and Respiratory Health Research, University of Oulu, PO Box 5000, 90014, Oulu, Finland. Electronic address: simo.nayha@oulu.fi.
authors.forename: S
authors.initials: S
authors.lastname: Näyhä
authors.affiliation: Centre for Arctic Medicine, Thule Institute, University of Oulu, PO Box 7300, 900014, Oulu, Finland. Electronic address: arja.rautio@oulu.fi.
authors.forename: A
authors.initials: A
authors.lastname: Rautio
authors.affiliation: Department of Geography, University of Oulu, PO Box 3000, 90014, Oulu, Finland. Electronic address: jarmo.rusanen@oulu.fi.
authors.forename: J
authors.initials: J
authors.lastname: Rusanen
authors.affiliation: Center for Life Course Epidemiology and Systems Medicine, University of Oulu, PO Box 5000, 90014, Oulu, Finland; Unit of General Practice, Oulu University Hospital, PO Box 5000, 900014 Oulu, Finland. Electronic address: anja.taanila@oulu.fi.
authors.forename: A
authors.initials: A
authors.lastname: Taanila
authors.affiliation: Center for Life Course Epidemiology and Systems Medicine, University of Oulu, PO Box 5000, 90014, Oulu, Finland. Electronic address: markku.koiranen@oulu.fi.
authors.forename: M
authors.initials: M
authors.lastname: Koiranen
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland; D005843:Geography; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Distance; Finland; GIS; Health service use; Rural-urban differences; Young adults