National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Science and Innovation, Madrid, Spain.
Int J Equity Health. 2017 Jan 9;16(1):4. doi: 10.1186/s12939-016-0498-2.
Though poorly known, relationships between disability, need of help (dependency) and use of social services are crucial aspects of public health. The objective of this study was to describe the links between disability, officially assessed dependency, and social service use by an industrial population, and identify areas of inequity.
We took advantage of a door-to-door survey conducted in the Cinco Villas district, Spain, in 2008-2009, which provided data on disability, morbidity, and service use among 1216 residents aged ≥50 years, and officially assessed dependency under the 2006 Dependency Act (OAD). Using logistic regression, we combined data collected at homes/residences on 625 disability screened-positive participants, and administrative information on degree of OAD and benefits at date of visit.
Based on 163 disabled persons, the prevalence of residential/community-care users was 13.4% overall, with 6.0% being market-provided, 2.5% supported by the 2006 Act, and 4.9% supported by other public funds. Of 111 OAD applicants, 30 had been assigned an OAD degree; in 29 cases this was the highest OAD degree, with 12 receiving direct support for residential care and 17 receiving home care. Compared to unassessed dependency, the highest OAD degree was linked to residential care (OR and 95% CI) 12.13 (3.86-38.16), declared non-professional care 10.99 (1.28-94.53), and publicly-funded, non-professional care 26.30 (3.36-205.88). In contrast, 43 persons, 58% of the severely/extremely disabled, community-dwelling sample population, 81% of whom were homebound, including 10 persons with OAD but no implemented service plan, made no use of any service, and of these, 40% lacked a non-professional carer.
Formal service use in the Cinco Villas district attained ratios observed for established welfare systems but the publicly-funded proportion was lower. The 2006 Act had a modest, albeit significant, impact on support for non-professional carers and residential care, coexisting with a high prevalence of non-use of social services by severely disabled persons.
尽管了解甚少，但残疾、需要帮助（依赖）和社会服务使用之间的关系是公共卫生的重要方面。本研究的目的是描述残疾、官方评估的依赖和工业人口使用社会服务之间的联系，并确定不平等领域。
我们利用 2008-2009 年在西班牙 Cinco Villas 区进行的一项挨家挨户调查，该调查提供了 1216 名≥50 岁居民的残疾、发病率和服务使用数据，以及根据 2006 年《依赖法》（OAD）进行的官方评估依赖程度的数据。使用逻辑回归，我们将在住宅/住所收集的 625 名残疾筛查阳性参与者的数据，以及在访问日期的 OAD 程度和福利的行政信息结合起来。
根据 163 名残疾人的数据，总体上有 13.4%的居住/社区护理使用者，其中 6.0%是市场提供的，2.5%是 2006 年法案支持的，4.9%是其他公共资金支持的。在 111 名 OAD 申请人中，有 30 人被分配了 OAD 程度；在 29 例中，这是最高的 OAD 程度，其中 12 人接受了直接的居住护理支持，17 人接受了家庭护理。与未经评估的依赖相比，最高的 OAD 程度与居住护理（比值比和 95%置信区间）12.13（3.86-38.16）、声明的非专业护理 10.99（1.28-94.53）和公共资助的非专业护理 26.30（3.36-205.88）相关。相比之下，43 人，即严重/极度残疾的社区居住样本人群的 58%，其中 81%的人无法外出，包括 10 名有 OAD 但没有实施服务计划的人，没有使用任何服务，其中 40%的人没有非专业护理人员。
Cinco Villas 区的正规服务使用达到了既定福利制度的比例，但公共资助的比例较低。2006 年法案对非专业护理人员和居住护理的支持产生了适度但显著的影响，同时严重残疾者高度不使用社会服务。
