Περίληψη σε άλλη γλώσσα
Background: Previous studies have shown that the socio-economic status has a negative impact on health and especially on Health Related Quality of Life (HRQoL). Greek studies usually focus on urban populations and the ethnicity parameter has not been fully elucidated. On the other hand, health inequalities seem to be affected by several factors including soocio-economic status, but most studies stress the fact that equality in health care utilization is mostly dependent upon parameters that determine health need. Taking into account that the Greek health system is a mixed public-private system, studying the demographic and socioeconomic characteristics of an urban and rural population in accordance with ethnicity and other factors that determine health care use is of great importance, especially when these factors determine HRQoL.Materials and Methods: This study was conducted in 2006 in the prefecture of Theassaly, an area of Central Greece, in a representative sample of 1372 individu ...
Background: Previous studies have shown that the socio-economic status has a negative impact on health and especially on Health Related Quality of Life (HRQoL). Greek studies usually focus on urban populations and the ethnicity parameter has not been fully elucidated. On the other hand, health inequalities seem to be affected by several factors including soocio-economic status, but most studies stress the fact that equality in health care utilization is mostly dependent upon parameters that determine health need. Taking into account that the Greek health system is a mixed public-private system, studying the demographic and socioeconomic characteristics of an urban and rural population in accordance with ethnicity and other factors that determine health care use is of great importance, especially when these factors determine HRQoL.Materials and Methods: This study was conducted in 2006 in the prefecture of Theassaly, an area of Central Greece, in a representative sample of 1372 individuals of the population in this area (> 18 yrs of age, response rate 91.4%) by personal interview. The questionnaire given included questions from the previously validated SF-36 and EuroQol (5D) questionnaires, whereas health need was determined by the self-perceived health status of the individuals, as measured by the two summary scores of physical (PCS) and mental (MCS) health of SF-36. Health care utilization was determined by: 1) visits to a private or public doctor within the last month, measuring primary care use and 2) emergency department visits and hospital admissions, measuring secondary health care. Furthermore, frequency of health care use was estimated together with the factors that determine health care utilization. Multivariate stepwise linear regression analysis was performed in order to determine the impact of demographic, socioeconomic and ethnicity characteristics on HRQoL, while interaction effects between socioeconomic and demographic variables were also investigated. Multivariable stepwise logistic regression analysis was also applied separately for the urban and rural population, in order to determine the predictors of health services utilization. Statistical significance was determined with a p value<0.05.Results: Low socioeconomic status as determined by primary education and low income was associated with impaired HRQoL in physical and mental health. Albanians reported better HRQoL compared to Greeks but after controlling for SES factors health disparities became insignificant. Rural residents were related to better general and mental health in comparison to the urban residents. Health care needs were the most significant determinants of primary and secondary health services utilization in both the urban and rural areas. Poor physical and mental health was associated with higher likelihood of use. In the urban areas middle-aged, elderly and Greeks were more likely to use primary health services, whereas primary education was associated with more visits to the emergency departments. Wealthier individuals were two times more likely to be admitted to hospitals. Individuals from the rural areas with university education visited more the public primary services, while wealthier individuals visited more the private practitioners. Immigrants had a higher likelihood of visiting emergency departments. Greeks and individuals with lower physical and mental health were more likely to visit a public doctor more than once.Conclusions: Rurality and urbanity appear to have differential impact on HRQoL. Physical functioning is related to socioeconomic status (SES), especially for the urban population, since the rural population only exhibited a small reduction according to SES. Ethnicity had a small impact on HRQoL, since it only affected two out of the eight scales of SF-36, indicating that SES is the most important variable affecting HRQoL. Despite the fact tha health care needs determine utilization of health services in the urban and rural population, socioeconomic differences and ethnicity significantly contributed to the inequalities observed in health care use. Ethniscity and the two summary scores of physical and mental health seem to have an impact on public primary health care visits. Such findings provide important information to policy makers, which attempt to reduce inequalities in health care according to place of residence and ethnicity. The development of policies that improve the structural mechanisms of health services and their socioeconomic development in rural areas of the periphery , could facilitate the reduction of health inequalities observed today and could improve the health status of the entire society.
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