Kottwitz Anita
German Socio-Economic Panel Study (SOEP), DIW Berlin, Mohrenstraße 58, 10117 Berlin, Germany; International Max Planck Research School on the Life Course (IMPRS LIFE), Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany.
Health Place. 2014 May;27:9-21. doi: 10.1016/j.healthplace.2014.01.005. Epub 2014 Jan 24.
Access to health care is an important factor in explaining health inequalities. This study focuses on the issue of access to health care as a driving force behind the social discrepancies in cesarean delivery using data from 707 newborn children in the 2006-2011 birth cohorts of the German Socio-Economic Panel Study (SOEP). Data on individual birth outcomes are linked to hospital data using extracts of the quality assessment reports of nearly all German hospitals. Geographic Information Systems (GIS) are used to assess hospital service clusters within a 20-km radius buffer around mother׳s homes. Logistic regression models adjusting for maternal characteristics indicate that the likelihood to deliver by a cesarean section increases for the least educated women when they face constraints with regard to access to hospital care. No differences between the education groups are observed when access to obstetric care is high, thus a high access to hospital care seems to balance out health inequalities that are related to differences in education. The results emphasize the importance of focusing on unequal access to hospital care in explaining differences in birth outcomes.
获得医疗保健是解释健康不平等现象的一个重要因素。本研究利用德国社会经济面板研究（SOEP）2006 - 2011年出生队列中707名新生儿的数据，将获得医疗保健的问题作为剖宫产社会差异背后的驱动力进行研究。个体出生结局数据与医院数据通过几乎所有德国医院的质量评估报告提取物相链接。地理信息系统（GIS）用于评估母亲住所周围20公里半径缓冲区内的医院服务集群。调整产妇特征的逻辑回归模型表明，受教育程度最低的女性在面临获得医院护理的限制时，剖宫产的可能性会增加。当获得产科护理的机会较高时，不同教育组之间未观察到差异，因此，获得医院护理的高机会似乎平衡了与教育差异相关的健康不平等。研究结果强调了在解释出生结局差异时关注获得医院护理不平等问题的重要性。
