Background and objectives-While socioeconomically derived diVerences in health and health services use have long been a subject of study, diVerences based on gender, considered as the explicative variable, have scarcely been quantified from population-based data. The aim of this investigation was to analyse inequalities in health and health care services utilisation between men and women in Catalonia (Spain). Design, setting, participants, and measures-Data from the Catalan Health Interview Survey, a cross sectional survey conducted in 1994, were used. A total of 6604 women and 5641 men aged 15 years or over were included for analysis. Health related variables studied were self perceived health, restriction of activity (past two weeks), and presence of chronic conditions; health services use variables analysed were having visited a health professional (past two weeks), an optometrist (12 months), or a dentist (12 months); and hospitalisation (past 12 months). Age standardised proportions were computed according to gender, and prevalence odds ratios (OR) were derived from logistic regression equations. Main results-Women more frequently rated their health as fair or poor than men (29.8% v 21.4%; OR=1.22; 95% CI: 1.10, 1.34). More women than men reported having restricted activity days (OR=1.86; 95% CI: 1.59, 2.18) and chronic conditions (OR=1.74; 95% CI: 1.60, 1.89). The proportion of women visiting a health professional was slightly greater than that for men (OR=1.20; 95% CI: 1.09, 1.31), as was the proportion of women visiting an optometrist (OR=1.21; 95% CI: 1.11, 1.33), and a dentist (OR=1.43; 95% CI: 1.31, 1.55). The proportion of hospitalisation was lower in women (6.6%) than in men (7.7%; OR=0.73; 95% CI: 0.63, 0.85). When health services use was analysed according to self perceived health, women declaring good health reported a greater probability of consulting a health professional (OR=1.35; 95% CI: 1.20, 1.52). There were no diVerences in respect to hospitalisation, visits to the optometrist and to the dentist. Conclusions-These results indicate a pattern close to the inverse care law, as women, who express a lower level of health and thus would need more health care, are not, however, using health services more frequently than men. (J Epidemiol Community Health 1999;53:218-222) While gender diVerences in health, assessed in terms of mortality and morbidity, have been reported in most developed countries over recent decades, 1-10 less attention has been paid to the pattern of health care services use.

The NHS in Catalonia, Spain, has reduced inequalities in the use of health services. Social inequalities remain in the use of those health services provided only partially by the NHS.

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In participants with SCI, cognitive dysfunctions are present in the subacute stage and worsen over time. From a clinical point of view, we confirmed the presence of cognitive dysfunction that may interfere with the first stage of rehabilitation which is the most intense and important. Moreover, cognitive dysfunction may be important beyond the end of the first stage of rehabilitation as it can affect an individual's quality of life and possible integration to society.

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