Les bases médico-administratives pour mesurer les inégalités sociales de santé

Ducros, Denis; Nicoules, Valérie; Chehoud, Haithem; Bayle, Annette; Souche, A.; Tanguy, Maëla; Valière, Jean-Paul; Cayla, Françoise; Grosclaude, Pascale

doi:10.3917/spub.153.0383

Cited by 8 publications

(11 citation statements)

References 14 publications

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“…This dataset has been described in detail elsewhere. 12 The health data was prospectively collected by the three main health insurance providers for 2012.…”

Section: Methodsmentioning

confidence: 99%

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Social and territorial inequalities in breast and cervical cancers screening uptake: a cross-sectional study in France

et al. 2022

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ObjectiveThe objective of this cross-sectional study was to investigate the impact of socio-territorial characteristics on mammography and pap smear uptake according to the place of residence in the recommended age groups, and second outside the recommended age groups.Setting and participantsWe used an existing dataset of 1 027 039 women which combines data from the Health Insurance information systems, with census data from Midi-Pyrénées, France.Primary and secondary outcome measuresOur outcome was, for each woman, the uptake of the pap smear and the uptake of the mammography during the year.ResultsA social gradient of screening uptake was found in the recommended age groups. This gradient was stronger in large urban areas:(1) For mammography: decile 10 (the most deprived) vs 1 (the least deprived), adjusted OR 0.777, 95% CI (0.748 to 0.808) in large urban area; adjusted OR= 0.808 for decile 1 to 0.726 for decile 10 in other areas vs decile 1 in urban areas;(2) For pap smear: decile 10 vs 1 adjusted OR 0.66, 95%CI (0.642 to 0.679) in large urban areas; adjusted OR= 0.747 for decile 1 to 0.562 for decile 10 in other areas vs decile 1 in urban areas).Screening rates were globally higher in large urban areas.For mammography, the social and territorial disparities were higher outside the recommended age group.ConclusionsOffering a universal approach to every woman, as it is often the case in nationally organised screening programmes, is likely to be insufficient to ensure real equity in access. Developing global dataset combining health data and diverse socioeconomic data, at individual and contextual levels, could enable a better understanding of the mechanisms involved in this social gradient, and therefore, the development of targeted territorial actions to improve equity of access to healthcare.

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“…This dataset has been described in detail elsewhere. 12 The health data was prospectively collected by the three main health insurance providers for 2012.…”

Section: Methodsmentioning

confidence: 99%

“…We used a dataset combining data from health insurance information systems with census data, based on the address of residence. This dataset has been described in detail elsewhere 12…”

Section: Methodsmentioning

confidence: 99%

Social and territorial inequalities in breast and cervical cancers screening uptake: a cross-sectional study in France

et al. 2022

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“…Data on health care consumption from 1 January to 31 December 2012 were collected. The database and its construction are described in detail elsewhere [13]. We selected all women aged 25-64 years, i.e.…”

Section: Methodsmentioning

confidence: 99%

Cervical cancer screening: inequality of screening, inequality of medical practice?

Druel¹,

Delpierre

Ouanhnon³

et al. 2023

Preprint

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Background Vulnerable social groups have more difficulty in accessing care and a lower quality of care. Health systems that focus on primary care appear to be more effective, efficient and equitable. However, difficulties in accessing primary care persist. We focused on primary care screening for cervical cancer by Cervico-Uterine Smear (CUS), which has been shown to be effective in reducing incidence and mortality. To analyse the population screened by CUS and the health professionals who perform these tests, and to analyse differences in access to care in socio-economic and geographical terms.Methods This was a retrospective observational study based on data from the main health insurance schemes, allowing analysis of health care consumption according to socioeconomic level, and proximity to health care services. We included women (695,694) aged 25 to 64 years in 2012 relevant to CUS. The sociodemographic and territorial indicators were age, geographical area deprivation, and the availability of gynaecological care. The analysis was performed by using multinomial logistic regression.Results 202,271 (29%) patients underwent CUS, 68% by gynaecologists and 28% by general practitioners (GPs). However, inequalities in CUS were observed, with a decrease in the number of CUS performed with age, rural location, deprivation, and sparse health care provision. GPs’ practice seemed to penalize deprived populations less.Conclusions Screening should be conducted more by GPs in primary care, thus providing better access to deprived populations. Health care should be organised more around primary care than hospital care. The specific needs of deprived populations should be considered.

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“…The design of this study was described in detail in a previous article that aimed to assess the socio-territorial determinants of access to healthcare[ 19 ]. Briefly, it is a cross-sectional study based on the joint use of the Health Insurance information systems, an ecological indicator of deprivation and an indicator of potential spatial accessibility of healthcare provision in the Midi-Pyrénées region.…”

Section: Methodsmentioning

confidence: 99%

“…Healthcare provision was measured by potential localised accessibility (PLA) to a general practitioner[ 9 ].It assesses the availability and proximity of healthcare, two dimensions characteristic of spatial access to healthcare at the township-level [ 26 ]. PLA was developed in France by the Department of Research, Studies, Evaluation and Statistics (DRESS), using North American works in particular[ 27 ].The method of calculating the PLA is presented in detail elsewhere[ 19 ]. Briefly, it considers a general practitioner’s level of activity, in full-time equivalence, to measure the distance-weighted supply and the age-differentiated rate of access to measure demand.…”

Section: Methodsmentioning

confidence: 99%

Disentangling the influence of living place and socioeconomic position on health services use among diabetes patients: A population-based study

et al. 2017

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This research investigates the influence of place of residence and diabetic patient’s socioeconomic position on their use of health services in a universal health care system. This retrospective cross-sectional population-based study is based on the joint use of the Health Insurance information systems, an ecological indicator of social deprivation and an indicator of potential spatial accessibility of healthcare provision in the Midi-Pyrénées region. Using French healthcare insurance population-based data on reimbursement of out-of-hospital care during the year 2012, we study the use of health services among patients aged 50 and over (n = 90,136).We built logistic regression models linking health services use to socioeconomic position by geographic area, adjusted for age, gender, healthcare provision, information regarding patients precariousness, and long-term condition, used as proxy for the state of health. After adjustment for healthcare provision, the lower population density in the geographical area of concern, the lower the access to specialised care, independent of the patients’ SEP. General practitioner attendance was higher among the patients with the lowest SEP without being clearly influenced by their living place. We found no clear influence of either patients’ SEP or their living place on their access to biological follow-up. This study is an attempt to account for the geographical context and to go further in studying the social determinants of health among diabetes patients.

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Les bases médico-administratives pour mesurer les inégalités sociales de santé

Cited by 8 publications

References 14 publications

Social and territorial inequalities in breast and cervical cancers screening uptake: a cross-sectional study in France

Social and territorial inequalities in breast and cervical cancers screening uptake: a cross-sectional study in France

Cervical cancer screening: inequality of screening, inequality of medical practice?

Disentangling the influence of living place and socioeconomic position on health services use among diabetes patients: A population-based study

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