Sociodemographic characteristics of the study population (n = 6754).

<p>Sociodemographic characteristics of the study population (n = 6754).</p

Socioeconomic Status and Use of Outpatient Medical Care: The Case of Germany

<div><p>Background</p><p>Socially disadvantaged people have an increased need for medical care due to a higher burden of health problems and chronic diseases. In Germany, outpatient care is chiefly provided by office-based general practitioners and specialists in private practice. People are free to choose the physician they prefer. In this study, national data were used to examine differences in the use of outpatient medical care by socioeconomic status (SES).</p><p>Methods</p><p>The analyses were based on data from 6,754 participants in the Robert Koch Institute’s German Health Interview and Examination Survey for Adults (DEGS1) aged between 18 and 69 years. The number of outpatient physician visits during the past twelve months was assessed for several medical specializations. SES was determined based on education, occupation, and income. Associations between SES and physician visits were analysed using logistic regression and zero-truncated negative binomial regression for count data.</p><p>Results</p><p>After adjusting for sociodemographic factors and health indicators, outpatients with low SES had more contacts with general practitioners than outpatients with high SES (men: incidence rate ratio [IRR] = 1.25; 95% confidence interval [CI] = 1.08–1.46; women: IRR = 1.20; 95% CI = 1.07–1.34). The use of specialists was lower in people with low SES than in those with high SES when sociodemographic factors and health indicators were adjusted for (men: odds ratio [OR] = 0.68; 95% CI = 0.51–0.91; women: OR = 0.56; 95% CI = 0.41–0.77). This applied particularly to specialists in internal medicine, dermatology, and gynaecology. The associations remained after additional adjustment for the type of health insurance and the regional density of office-based physicians.</p><p>Conclusion</p><p>The findings suggest that socially disadvantaged people are seen by general practitioners more often than the socially better-off, who are more likely to visit a medical specialist. These differences may be due to differences in patient preferences, physician factors, physician-patient interaction, and potential barriers to accessing specialist care.</p></div

Utilization of office-based general practitioners by socioeconomic status in men and women.

<p>Utilization of office-based general practitioners by socioeconomic status in men and women.</p

Utilization of office-based physicians with different medical specialities by socioeconomic status in men and women.

<p>Utilization of office-based physicians with different medical specialities by socioeconomic status in men and women.</p

Health and health risk behaviour of adolescents—Differences according to family structure. Results of the German KiGGS cohort study

<div><p>Objective</p><p>This study’s aim was to investigate the association between family structure and different health-related outcomes in adolescence (self-rated health, emotional and behavioural problems, health-related quality of life, regular smoking, and heavy episodic drinking). Furthermore, we analysed the extent to which socio-economic status, family cohesion and the pre-transition health status explain family structure-related health disparities.</p><p>Methods</p><p>We used longitudinal data from the first two waves of the German KiGGS cohort study carried out by the Robert Koch Institute (baseline: 2003–2006, follow-up: 2009–2012). The sample comprised 4,692 respondents aged 11 to 17 years. Using data from both waves, effects of family structure on health status at follow-up were calculated applying linear and logistic regression models.</p><p>Results</p><p>We found that adolescents continuously living with both birth parents were in good health. Adolescents whose parents separated after the baseline survey, reported poorer health and were more likely to smoke. The transition from stepfamily to single parent family was also associated with a higher risk of regular smoking. Lower health-related quality of life as well as higher scores for emotional and behavioural problems occurred in almost all non-nuclear family structures, although not all effects were statistically significant. No significant effects of family structure on heavy episodic drinking were found. While family cohesion mediated the effects of family structure on adolescents’ health, the mediating effect of socio-economic status was small. After controlling for pre-transition health, the effects were even lower.</p><p>Conclusions</p><p>Because the direct effects of family structure on adolescents’ health were small and family cohesion was found to be an important mediator in the association between family structure and adolescents’ health, prevention programmes and interventions should be directed towards the parent–adolescent relationship rather than just the family structure, in order to minimize the psychosocial stress of adolescents during the period of family transition.</p></div

Sample characteristics.

<p>Sample characteristics.</p

Results from the logistic regression models on heavy episodic drinking.

<p>Adolescents aged 14 to 17 years.</p

Results from the linear regression models on self-rated health.

<p>Adolescents aged 11 to 17 years.</p

Mean values / proportions of the health outcomes according to family status.

<p>Mean values / proportions of the health outcomes according to family status.</p

Results from the linear regression models on health-related quality of life.

<p>Adolescents aged 11 to 17 years.</p