Lorant V, Boland B, Humblet P, Deliège D
Health Sociology and Economics, School of Public Health, Faculty of Medicine, Université Catholique de Louvain, Brussels, Belgium.
J Epidemiol Community Health. 2002 Jul;56(7):510-6. doi: 10.1136/jech.56.7.510.
There is an increasing body of evidence about socioeconomic inequality in preventive use, mostly for cancer screening. But as far as needs of prevention are unequally distributed, even equal use may not be fair. Moreover, prevention might be unequally used in the same way as health care in general. The objective of the paper is to assess inequity in prevention and to compare socioeconomic inequity in preventive medicine with that in health care.
A cross sectional Health Interview Survey was carried out in 1997 by face to face interview and self administered questionnaire. Two types of health care utilisation were considered (contacts with GPs and with specialists) and four preventive care mostly delivered in a GP setting (flu vaccination, cholesterol screening) or in a specialty setting (mammography and pap smear).
Belgium.
A representative sample of 7378 residents aged 25 years and over (participation rate: 61%).
Socioeconomic inequity was measured by the HI(wvp) index, which is the difference between use inequality and needs inequality. Needs was computed as the expected use by the risk factors or target groups.
There was significant inequity for all medical contacts and preventive medicine. Medical contacts showed inequity favouring the rich for specialist visits and inequity favouring the poor for contacts with GPs. Regarding preventive medicine, inequity was high and favoured the rich for mammography and cervical screening; inequity was lower for flu immunisation and cholesterol screening but still favoured the higher socioeconomic groups. In the general practice setting, inequity in prevention was higher than inequity in health care; in the specialty setting, inequity in prevention was not statistically different from inequity in health care, although it was higher than in the general practice setting.
If inequity in preventive medicine is to be lowered, the role of the GP must be fostered and access to specialty medicine increased, especially for cancer screening.
关于预防性医疗使用方面社会经济不平等的证据越来越多，主要涉及癌症筛查。但鉴于预防需求分布不均，即便使用情况相同也可能不公平。此外，预防措施的使用方式可能与总体医疗保健一样存在不平等。本文的目的是评估预防方面的不公平现象，并比较预防医学与医疗保健领域的社会经济不平等情况。
1997年通过面对面访谈和自填问卷开展了一项横断面健康访谈调查。考虑了两种类型的医疗保健利用情况（与全科医生和专科医生的接触）以及四种主要在全科医生诊所（流感疫苗接种、胆固醇筛查）或专科诊所（乳房X光检查和巴氏涂片检查）提供的预防保健服务。
比利时。
7378名25岁及以上居民的代表性样本（参与率：61%）。
社会经济不平等通过HI(wvp)指数衡量，该指数是使用不平等与需求不平等之间的差值。需求根据风险因素或目标群体的预期使用情况计算得出。
所有医疗接触和预防医学均存在显著的不公平现象。医疗接触方面，专科就诊存在有利于富人的不公平现象，而与全科医生接触则存在有利于穷人的不公平现象。在预防医学方面，不公平现象严重，乳房X光检查和宫颈癌筛查有利于富人；流感免疫接种和胆固醇筛查的不公平现象较低，但仍有利于社会经济地位较高的群体。在全科医疗环境中，预防方面的不公平高于医疗保健方面的不公平；在专科医疗环境中，预防方面的不公平与医疗保健方面的不公平在统计学上无差异，尽管高于全科医疗环境中的不公平。
若要降低预防医学中的不公平现象，必须加强全科医生的作用并增加专科医疗服务的可及性，尤其是癌症筛查服务。
