title: How do socio-economic factors and distance predict access to prevention and rehabilitation services in a Danish municipality?
abstract: Aim The aim was to explore the extent to which a Danish prevention centre catered to marginalised groups within the catchment area. We determined whether the district's socio-economic vulnerability status and distance from the citizens' residential sector to the centre influenced referrals of citizens to the centre, their attendance at initial appointment, and completion of planned activities at the centre.
  
  
  
  Disparities in access to health care services is one among many aspects of inequality in health. There are multiple determinants within populations (socio-economic status, ethnicity, and education) as well as the health care systems (resource availability and cultural acceptability).
  
  
  
  A total of 347 participants referred to the centre during a 10-month period were included. For each of 44 districts within the catchment area, the degree of socio-economic vulnerability was estimated based on the citizens' educational level, ethnicity, income, and unemployment rate. A socio-economic vulnerability score (SE-score) was calculated. Logistic regression was used to calculate the probability that a person was referred to the centre, attended the initial appointment, and completed the planned activities, depending on sex, age, SE-score of district of residence, and distance to the centre. Findings Citizens from locations with a high socio-economic vulnerability had increased probability of being referred by general practitioners, hospitals, and job centres. Citizens living further away from the prevention centre had a reduced probability of being referred by their general practitioners. After referral, there was no difference in probability of attendance or completion as a function of SE-score or distance between the citizens' district and the centre. In conclusion, the centre is capable of attracting referrals from districts where the need is likely to be relatively high in terms of socio-economic vulnerability, whereas distance reduced the probability of referral. No differences were found in attendance or completion.
authors: 1Department of Learning and Philosophy, Aalborg University,Denmark.
authors: Anette L
authors: AL
authors: Hindhede
authors: 2Health Promotion Research, Steno Diabetes Center,Denmark.
authors: Ane
authors: A
authors: Bonde
authors: 3Department of Sport Science and Clinical Biomechanics,University of Southern Denmark,Denmark.
authors: Jasper
authors: J
authors: Schipperijn
authors: 4The Danish Cancer Society,Denmark.
authors: Stine H
authors: SH
authors: Scheuer
authors: 5Prevention Center Vanløse, Municipality of Copenhagen,Denmark.
authors: Susanne M
authors: SM
authors: Sørensen
authors: 2Health Promotion Research, Steno Diabetes Center,Denmark.
authors: Jens
authors: J
authors: Aagaard-Hansen
mesh_terms: D000328:Adult; D003718:Denmark; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011315:Preventive Medicine / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors
keywords: Denmark; access; distance; health services; inequity; municipality; prevention; rehabilitation; socioeconomic determinants; utilization