Fach Eva-Maria, Markert Jenny, Spanier Katja, Bethge Matthias, Schlumbohm Anna, Richter Matthias
Institut für Medizinische Soziologie, Martin-Luther-Universität Halle-Wittenberg.
Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck.
Rehabilitation (Stuttg). 2021 Oct;60(5):310-319. doi: 10.1055/a-1343-5586. Epub 2021 Apr 19.
The influence of social status on health is well documented. Preliminary research provides initial evidence for social inequalities in rehabilitation care. Our study examines the role of social inequalities with respect to access and utilisation of medical rehabilitation services by analysing a risk cohort of the German Statutory Pension Insurance Scheme (Deutsche Rentenversicherung Bund).
Data for the analysis consists of questionnaire data from the first two waves of the Third German Socio-medical Panel of Employees (GSPE-III) and administrative data of participants (2013-2016). This risk cohort comprises 40-54-year-old employees receiving sickness benefits in 2012. Using logistic regression models, the application for medical rehabilitation, its approval and rejection, possible opposition proceedings and its subsequent utilisation were analysed. The social status was measured by an index as well as by the single dimension of education. The analyses were carried out separately by gender. Age, employment status and subjective health status were considered as covariates.
A total of 2.376 insured employees, 1.092 men and 1.284 women, were included in the analysis. 639 (26.9%) submitted at least one application for medical rehabilitation. The chance of submitting an application was higher for men with low socioeconomic status (OR=1.8; 95%-CI=1.3-2.5) or lower (OR=1.9; 95%-CI=1.3-2.8) and medium education (OR=1.5; 95%-CI=1.1-2.2) in relation to the high status or education group. For women, low education (OR=1.6; 95%-CI=1.1-2.5) raised the chances of an application. When adjusted for health status and current employment situation, all significant differences disappeared. Regarding approval and utilisation, there were no significant differences between socioeconomic status groups, but women with a medium level of education were significantly more likely to have their application approved on the basis of an opposition proceeding (OR=3.0; 95%-CI=1.1-8.2) than women with a high level of education.
The analyses provided no evidence of a socially unequal access to or utilization of medical rehabilitation. However, insured persons with a low social status more frequently applied for rehabilitation, especially because of their poorer subjective health. Further research is needed to ensure that this meets the objective needs of this status group.
社会地位对健康的影响已有充分记录。初步研究为康复护理中的社会不平等提供了初步证据。我们的研究通过分析德国法定养老保险计划（德国联邦养老保险）的一个风险队列，考察了社会不平等在医疗康复服务获取和利用方面的作用。
分析数据包括来自德国员工第三次社会医学调查（GSPE - III）前两波的问卷数据以及参与者的行政数据（2013 - 2016年）。这个风险队列包括2012年领取病假津贴的40 - 54岁员工。使用逻辑回归模型，分析了医疗康复申请、申请的批准与拒绝、可能的申诉程序及其后续利用情况。社会地位通过一个指数以及教育这一单一维度来衡量。分析按性别分别进行。年龄、就业状况和主观健康状况被视为协变量。
共有2376名参保员工，其中男性1092名，女性1284名纳入分析。639人（26.9%）至少提交了一份医疗康复申请。社会经济地位低的男性（比值比=1.8；95%置信区间=1.3 - 2.5）或中等教育程度（比值比=1.5；95%置信区间=1.1 - 2.2）的男性相对于高地位或高教育程度组，提交申请的可能性更高；社会经济地位低的男性（比值比=1.9；95%置信区间=1.3 - 2.8）提交申请的可能性也更高。对于女性，低教育程度（比值比=1.6；95%置信区间=1.1 - 2.5）增加了申请的可能性。在对健康状况和当前就业状况进行调整后，所有显著差异均消失。关于批准和利用情况，社会经济地位组之间没有显著差异，但中等教育程度的女性基于申诉程序申请获得批准的可能性（比值比=3.0；95%置信区间=1.1 - 8.2）显著高于高教育程度的女性。
分析没有提供社会在医疗康复获取或利用方面不平等的证据。然而，社会地位低的参保人员申请康复的频率更高，尤其是因为他们的主观健康状况较差。需要进一步研究以确保这满足该地位群体的客观需求。
