Williams R
Soc Sci Med. 1987;24(2):109-15. doi: 10.1016/0277-9536(87)90243-7.
Access to health care may be influenced by a variety of factors including ones attributable to the individual as well as ones attributable to the health care system. One category frequently referred to is 'geographic' factors of distance and travel time. In the present study, a previously undescribed geographic factor--unpaved roads--is shown to be a clinically important barrier to access. Using a case-control format, children admitted with bacterial meningitis are shown to have traveled farther over unpaved roads to get to a clinic than matched controls seen at the same time. With control groups matched for age and similar pre-existing illness, the implication is that unpaved roads resulted in increased morbidity by reducing access.
获得医疗保健可能受到多种因素的影响，包括个体因素以及医疗保健系统因素。经常提到的一类因素是距离和出行时间等“地理”因素。在本研究中，一种先前未被描述的地理因素——未铺砌的道路——被证明是获得医疗保健的一个重要临床障碍。采用病例对照形式，研究表明，患细菌性脑膜炎入院的儿童比起同时期的匹配对照组，在前往诊所的途中要在未铺砌的道路上走更远的距离。在年龄和原有疾病相似的对照组中，这意味着未铺砌的道路通过减少获得医疗保健的机会导致发病率上升。
