Use of preventive health care services among the unemployed in Croatia

Vončina, Luka and Pristaš, Ivan and Mastilica, Miroslav and Polašek, Ozren and Šošić, Zvonko and Stevanović, Ranko (2007) Use of preventive health care services among the unemployed in Croatia. Croatian Medical Journal, 48 (5). pp. 667-674. ISSN 0353-9504

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Abstract

AIM: To analyze the association between unemployment and the use of preventive health care services in Croatia. ----- METHODS: Data on the use of preventive health care services and employment status were taken from the 2003 Croatia Adult Health Survey. A multistage stratified sample design was used to define a representative sample (n=9070 individuals) of the Croatian general adult population. Binary logistic regression was used for analysis. Odds ratios were estimated for the association between employment status and preventive health care services, controlling for age, sex, region, marital status, level of education, occupation, and distance from general practitioner (GP) facilities. ----- RESULTS: Our sample comprised 1356 men and 1932 women. Out of them, 382 men (28.2%) and 472 women (24.4%) were unemployed. Unemployment was negatively associated with the use of some preventive health care services in the year before the study among healthy individuals (regular blood pressure control odds ratio [OR], 0.738, 95% CI, 0.576-0.945; blood glucose control OR, 0.751, 95% CI, 0.565-0.999; attending general preventive examinations OR, 0.563, 95% CI, 0.410-0.772) as well as among individuals who reported cardiovascular and/or metabolic diseases (attending general preventive examinations OR, 0.661, 95% CI, 0.456-0.959; receiving doctor's advice for food habit change and influenza immunizations OR, 0.627, 95% CI, 0.424-0.928). ----- CONCLUSION: Both the unemployed who had cardiovascular and metabolic diseases and those who did not, used less preventive health services than respective subgroups of the employed. In order to achieve a more equitable distribution of preventive health care services, the Croatian health care system should provide additional attention to the unemployed; for instance by developing a program of preventive health examinations targeting this vulnerable population.

Abstract in Croatian

CILJ: Ispitati povezanost nezaposlenosti i korištenja preventivne zdravstvene zaštite u Hrvatskoj. ----- POSTUPCI: Podatci o korištenju preventivnom zdravstvenom zaštitom i podatci o zaposlenosti uzeti su iz Ankete o zdravlju odraslih u Hrvatskoj iz godine 2003. Stupnjeviti stratificirani uzorak upotrijebljen je da se odredi reprezentativan uzorak (n=9070) opće hrvatske populacije odraslih osoba. Za statističku obradbu podataka rabljena je postupna binarna logistička regresija. Za procjenu povezanosti nezaposlenosti i uporabe preventivne zdravstvene zaštite rabljen je omjer izgleda, uz kontrolu u odnosu na dob, spol, područje države, vjeru, bračno stanje, stupanj obrazovanja i udaljenost od ambulante liječnika opće prakse. ----- REZULTATI: Uzorak je obuhvatio 1356 muškaraca i 1932 žene. Nezaposlena su među njima bila 382 muškarca (28.2%) i 472 žene (24.4%). Među zdravim osobama, nezaposlenost je bila negativno povezana s korištenjem nekih oblika preventivne zdravstvene zaštite u godini prije istraživanja (redovita kontrola krvnoga tlaka, omjer izgleda [OR], 0.738, 95% raspon pouzdanosti [CI], 0.576- 0.945; kontrola koncentracije šećera u krvi OR, 0.751, 95% CI, 0.565-0.999; provođenje preventivnoga pregleda OR, 0.563, 95% CI, 0.410-0.772). Slično je pokazano i među osobama koje su prijavile kardiovaskularne ili metaboličke bolesti (provođenje preventivnoga pregleda OR, 0.661, 95% CI, 0.456-0.959; dobivanje liječničkoga savjeta o promjeni prehrambenih navika i cijepljenju protiv gripe OR, 0.627, 95% CI, 0.424-0.928). ----- ZAKLJUČCI: Nezaposlene osobe koje jesu i koje nisu imale kardiovaskularnih ili metaboličkih bolesti manje su se koristile preventivnom zdravstvenom zaštitom nego li njima prispodobive skupine zaposlenih osoba. Da bi postigao jednakomjerniju raspodjelu preventivne zdravstvene zaštite, hrvatski sustav zdravstvene zaštite mora dodatnu pozornost posvetiti nezaposlenima, primjerice uvođenjem programa preventivnih zdravstvenih pregleda za tu osjetljivu skupinu osoba.

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