The role country of birth plays in receiving disability pensions in relation to patterns of health care utilisation and socioeconomic differences: a multilevel analysis of Malmo, Sweden
The role country of birth plays in receiving disability pensions in relation to patterns of health care utilisation and socioeconomic differences: a multilevel analysis of Malmo, Sweden
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DOI：
10.1186/1471-2458-6-71
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发表时间：
2006-03-16
影响因子：
4.5
通讯作者：
Merlo, J
中科院分区：
文献类型：
--
作者：
Beckman, A;Hakansson, A;Merlo, J
背景：与社会经济地位高的人相比，社会经济地位低的人健康状况较差，获得残疾养老金的可能性也更高。众所周知，公立和私立全科医生以及公立和私立专科医生在签发病假证明方面有不同的做法（如果长期有效，可能会成为残疾养恤金的基础）。然而，很少有研究调查患者出生国在这种情况下的影响。方法：我们对嵌套在出生国（第二级）内的个体（第一级）进行多级逻辑回归分析。 2003 年，我们分析了瑞典马尔默市 40 至 64 岁之间的全部人口 (n = 80 212)，并确定其中 73% 的人口在那一年至少看过一次医生。我们研究了个人与出生国社会经济特征之间的关联，以及不同类型医生的个人使用情况与获得残疾养老金的关系。结果：独居（ORwomen = 1.72，95% CI：1.62 - 1.82；ORmen = 2.64，95% CI：2.46 - 2.83）且教育成绩有限（ORwomen = 2.14，95% CI：2.46 - 2.83） CI：2.00 - 2.29；ORmen = 2.12，95% CI：1.98 - 2.28）与拥有残疾养老金呈正相关。使用公共专科医生与拥有残疾养老金的概率较高（OR女性 = 2.11，95% CI：1.98 - 2.25；ORmen = 2.16，95% CI：2.01 - 2.32），而使用私人全科医生则与拥有残疾养老金的概率较低（OR男性 = 0.76，95% CI：0.69 - 0.83）相关。然而，这些协会因出生国而异。除了个人社会经济地位之外，来自中等收入国家的男性更有可能获得残疾养老金（ORmen = 1.61，95% CI：1.06 - 2.44）。结论：出生国似乎在理解个人社会经济差异如何影响领取残疾养老金的可能性以及相关的医疗保健利用模式方面发挥着重要作用。
Background: People of low socioeconomic status have worse health and a higher probability of being granted a disability pension than people of high socioeconomic status. It is also known that public and private general physicians and public and private specialists have varying practices for issuing sick leave certificates ( which, if longstanding, may become the basis of disability pensions). However, few studies have investigated the influence of a patient's country of birth in this context.Methods: We used multilevel logistic regression analysis with individuals ( first level) nested within countries of birth ( second level). We analysed the entire population between the ages of 40 and 64 years ( n = 80 212) in the city of Malmo, Sweden, in 2003, and identified 73% of that population who had visited a physician at least once during that year. We studied the associations between individuals and country of birth socioeconomic characteristics, as well as individual utilisation of different kinds of physicians in relation to having been granted a disability pension.Results: Living alone ( ORwomen = 1.72, 95% CI: 1.62 - 1.82; ORmen = 2.64, 95% CI: 2.46 - 2.83) and having limited educational achievement (ORwomen = 2.14, 95% CI: 2.00 - 2.29; ORmen = 2.12, 95% CI: 1.98 - 2.28) were positively associated with having a disability pension. Utilisation of public specialists was associated with a higher probability (ORwomen = 2.11, 95% CI: 1.98 - 2.25; ORmen = 2.16, 95% CI: 2.01 - 2.32) and utilisation of private GPs with a lower probability (ORmen = 0.76, 95% CI: 0.69 - 0.83) of having a disability pension. However, these associations differed by countries of birth. Over and above individual socioeconomic status, men from middle income countries had a higher probability of having a disability pension (ORmen = 1.61, 95% CI: 1.06 - 2.44).Conclusion: The country of one's birth appears to play a significant role in understanding how individual socioeconomic differences bear on the likelihood of receiving a disability pension and on associated patterns of health care utilisation.