Socioeconomic differences in general practice consultation rates in patients aged 65 and over: prospective cohort study

Abstract

Objective To examine socioeconomic differences in general practice consultation rates among patients aged 65 years and over. Design Secondary analysis of data from the fourth national survey of morbidity in general practice. Setting 60 general practices in England and Wales. Subjects 71 984 people aged 65 years and over. Main outcome measures Annual contact rates and home visiting rates with general practitioners and practice nurses. Results Social class differences in contact rates were greatest in 65-74 year olds, with rates 23% higher in patients from social class V than in class I (4.82 v 3.93 per person). In 75-84 year olds there was no clear association between social class and contact rates, and in people aged >85 years contact rates were highest in patients from class I. Home visiting rates were twice as high in patients from class V as in patients from class I (1.38 v 0.66 per person). Contact rates were 17% higher in people living in communal establishments and 8% higher in those living alone than in those living with others but not in a communal establishment. 66% of contacts with patients in communal establishments and 26% of those with patients living alone were in patients' homes compared with 18% with those living in standard accommodation. These differences persisted after adjustment in a generalised linear model. Conclusions Elderly people show socioeconomic differences in consultation rates. The extra workload generated by elderly people living alone and in communal establishments suggests additional payments to general practitioners are needed.

Socioeconomic Inequalities and Self-Rated Health: A Multilevel Study of Italian Elderly

“…The relationship between health and socioeconomic status has been explained to some extent by the prevalence among socioeconomically disadvantaged people of unhealthy or health-damaging behaviors, which increases exposure to certain risk factors (Borg and Kristensen 2000;Molarius et al 2006); or by their minor skills in using the existing health facilities and services in an optimal way or adopting prevention behaviors (McNiece and Majeed 1999). Additional studies have confirmed these results for the Italian population (Voller and Buiatti 2006;ISTAT 2007a;Pirani and Salvini 2011).…”

Healthcare utilisation among the Belgian elderly in relation to their socio-economic status

“…Some European studies suggest that elderly persons with a lower SES are more likely to contact a GP, even after controlling for health status, and less likely to contact a specialist than the elderly in higher socio-economic groups [4][5][6][7]. Broese van Groenou [8] took the position that higher healthcare utilisation (including contacts with GP and specialist) among the elderly is mainly determined by their health status and not by their SES.…”

Morbidity severity classifying routine consultations from English and Dutch general practice indicated physical health status

“…First, internal validity [11] was tested in older English consulters, with the construct hypotheses that all four ordinal scales of morbidity severity would be positively associated with older age, females, higher deprivation, and poorer physical health adjusting for the same sociodemographic factors. Current evidence indicates that adverse health states are more common in older age groups [24], females [25], and those from economically deprived groups [26]. Second, external validation was tested by the hypothesis that the strength of associations observed in older English consulters would be similar in older Dutch consulters (aged 50 years and over) and separately that the associations would show similar trends in younger Dutch consulters (18e49 years).…”