Inequality in health and health service use for mothers of young children in south west England. Survey Team of the Avon Longitudinal Study of Pregnancy and Childhood Team.

摘要

OBJECTIVE: To establish the degree of association between relative deprivation and any variation in condition specific morbidity and in consultations with general practitioners for mothers of young children. STUDY DESIGN: Condition specific morbidity and general practitioner consultation (GP) rates were recorded by means of self reports on a postal questionnaire. Subjects were asked to record whether they had suffered from any of 16 common conditions and, if so, whether they had consulted the GP. Relative deprivation was measured using indicators such as home ownership, overcrowded living conditions, car ownership, and partners' employment status. Information was also collected about the women's own employment status, their ages, and parity. SETTING: The three district health authorities of Bristol. All women expecting a baby between April 1991 and December 1992 were invited to participate. SUBJECTS: Altogether 11040 mothers who completed questionnaires about their own health and well being at 8 months postpartum as part of the Avon longitudinal study of pregnancy and childhood. OUTCOME MEASURES: The percentage of mothers reporting any of 16 common conditions since the birth of their child and the proportion of them who consulted the GP if a condition was reported. chi 2 tests of independence were used to examine the association between condition specific morbidity and social, demographic, and maternal characteristics. Latent class analysis was used to "cluster" mothers according to the particular configuration of social, demographic, and maternal characteristics associated with levels of morbidity for each of the six most commonly reported conditions. The probability of consulting a GP was then compared between clusters. RESULTS: Relative deprivation had a greater impact on morbidity and GP consultation for stress related conditions such as depression, anxiety, and headache/migraine. For all these conditions, higher levels of self reported morbidity and a greater probability of consulting the doctor were associated with a cluster of social disadvantage-living in rented accommodation, non-employment, younger age, and lower educational status. For other conditions such as backache, haemorrhoids, and cough/cold, however, higher morbidity was associated with a cluster of advantage-home ownership, uncrowded living conditions, use of car, and partner in employment. Where there was variation in the probability of consulting the GP for these conditions, it was linked to parity rather than socioeconomic factors. Higher levels of morbidity for all but one condition (backache) were also associated with having more than one child, but this cross-cut socioeconomic and demographic cluster characteristics; both more affluent, older mothers and younger, more deprived mothers were likely to be multiparous. CONCLUSIONS: Relative deprivation was associated with poorer mental but not physical health for this population of mothers of young children. These findings have implications for a more targeted approach to reducing inequality in health. The importance of examining inequality in health for women in relation to their own material circumstances, their employment status, and parity, is emphasised.