Education, disease prevalence and health service utilization in the Swiss National Health Survey “SOMIPOPS”

doi:10.1016/0091-7435(89)90005-4

Preventive Medicine

Volume 18, Issue 4, July 1989, Pages 452-459

https://doi.org/10.1016/0091-7435(89)90005-4 Get rights and content

Abstract

The relation among education, disease prevalence, and frequency of health service utilization was analyzed using data from the Swiss National Health Survey SOMIPOPS, conducted in 1981–1983 on a randomly selected sample of 4,255 individuals, representative of the entire Swiss population. The prevalence of several important cardiovascular, respiratory, digestive, osteoarticular, and psychiatric disorders was higher among less educated individuals; only allergic conditions were directly associated with indicators of social class. More educated individuals reported lower frequencies of general practitioner visits, but higher frequencies of specialized consultations. These findings confirm that education is an important determinant not only of mortality but also of morbidity and health-care utilization and require careful consideration in terms of the planning and evaluation of health services.

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Cited by (21)

Evaluation of pushing out of children from all English state schools: Administrative data cohort study of children receiving social care and their peers
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Citation Excerpt :
Observed links between education and health across life are so persistent over time and place that education has been labelled a “fundamental cause” of inequalities in health (Montez and Friedman, 2015). Higher levels of education are associated with lower risks of mortality (Montez and Friedman, 2015) and morbidity across life, measured using a wide range of indicators including self-rated health (Ljungdahl and Bremberg, 2015; Lynch, 2003; Ross and Wu, 1995), obesity (Hamad et al., 2018; Ljungdahl and Bremberg, 2015), cardiovascular disease (Feldman et al., 1989; Gutzwiller et al., 1989; Yang et al., 2019), depression (Lorant, 2003), cancer (Yang et al., 2019), and others, all of which are major public health issues globally. Besides health, education also gives access to other social resources, such as better paid and better quality employment, and has been associated with social outcomes such as higher social trust, more tolerant attitudes to others, and national development (Hodgson, 1998).
Pushing out (off-rolling) occurs where pupils are illegally excluded from school. Those receiving children's social care (CSC) services (children in need (CiN), on child protection plans (CPPs) or looked after (CLA)) are thought to be at increased risk, but limited evidence inhibits understanding of this phenomenon. The extent of pushing out can be inferred from non-enrolment in administrative data.
To estimate proportions of children not enrolled across secondary school (aged 11–16, up to year 11) and to explore the association between CSC history and non-enrolment in year 10/11.
>1 M pupils in year 7 (aged 11/12) in English state schools, 2011/12 and 2012/13.
We estimated the proportion of children not enrolled across years 8 to 11, disaggregated by CSC history. We assessed with regression modelling the association between CSC history and non-enrolment in years 10/11.
Of children without CSC history, 3.8% had ≥1 year not enrolled by year 11. This was higher in those with a history CiN (8.1%), CPP (9.4%) or CLA (10.4%) status. The odds of non-enrolment in years 10/11 were higher among those with CLA history vs non-exposed peers (OR 4.76, 95% CI 4.49–5.05) as well as in those with CPP history (3.60, 3.39–3.81) and CiN history (2.53, 2.49–2.58). History of special educational needs further increased non-enrolment odds, including after confounder adjustment.
Findings imply that children with CSC history are more likely to be pushed out from school than children without, especially those with special educational needs.
Psychoactive drug use among medical doctors is higher than in the general population
1991, Social Science and Medicine
We surveyed a representative sample of practising physicians and a representative sample of subjects from the Swiss general population (SOMIPOPS Survey) concerning their annual use of sleeping pills and tranquillizers. 77% of the physicians (n = 466) and 72% of the general population (n = 4255) responded. After adjustment for age and sex 37.1% of the doctors (general population 21.1% P<0.001) claimed to have taken these drugs for therapeutic purposes. The proportion of psychiatrists who reported taking sleeping pills and tranquillizers daily (10.6%) were significantly greater than for the population of doctors as a whole and for the general population (P <0.05). Regular users (i.e. subjects taking one mood altering drug at least once a week) accounted for 11.1% of the medical population compared with 6.8% of the general population (P<0.01). This over-consumption was wholly due to the greater number of regular users of psychoactive drugs amongst doctors less than 50 years of age relative to the general population or to subjects in higher management (from P <0.05 to P<0.001). Without this specific over-use, members of the medical profession would not have been found to use more psychoactive drugs than the general population and the executives. This result suggests that it would be worth investigating the mechanisms of response and adjustment (coping) to the specific stress that appears to be inherent in the exercice of medical practice.
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A population-based analysis of the health experience of African Nova Scotians
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People of African descent living in Britain and the United States have higher rates of morbidity from chronic disease than among the general population. We investigated whether the same applied to people of African descent living in a Canadian province.
We used administrative data to calculate 10-year cumulative incidence rate ratios for the period 1996–2005 for treated circulatory disease, diabetes mellitus and psychiatric disorders in Preston (population 2425), a community of predominantly African Nova Scotians. We used data for the province of Nova Scotia as a whole as the population reference standard. We also calculated 10-year incidence rate ratios for visits to family physicians and specialists and for admissions to hospital. We compared these findings with those in 7 predominantly white communities in Nova Scotia with otherwise similar socio-economic characteristics.
In the province as a whole, we identified 787 787 incident cases for the 3 disease groups over the 10-year period. Incidence rate ratios for the community of interest relative to the provincial population were significantly elevated for the 3 diseases: circulatory disease (1.19, 95% CI 1.08–1.29), diabetes (1.43, 95% CI 1.21–1.64) and psychiatric disorders (1.13, 95% CI 1.06–1.20). Incidence rate ratios in the community of interest were also higher than those in the comparison communities. Visits to family physicians and specialists for circulatory disease and diabetes were similarly elevated, but the pattern was less clear for visits for psychiatric disorders and hospital admissions.
African Nova Scotians had higher morbidity levels associated with treated disease, which could not be explained by socio-economic characteristics, recent immigration or language. Apart from psychiatric disorders, use of specialist services was consistent with morbidity. Further study is needed to investigate the relative contribution of genetic, biological, behavioural, psychosocial and environmental factors.
Une version française de ce résumé est disponible à l'adresse www.cmaj.ca/cgi/content/full/179/7/653/DC1
CMAJ 2008;179(7):653–8
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2021, Quality and Quantity
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^☆: The Health Survey SOMIPOPS (sociomedical indicators for the population of Switzerland) is a project within the Swiss National Research Programme No. 8 (“Efficiency and Efficacy in Swiss Health Services”), Swiss National Science Foundation Grant No. 4.350.79.08.

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Education, disease prevalence and health service utilization in the Swiss National Health Survey “SOMIPOPS”☆

Abstract

Lancet

Lancet

J Chron Dis

Inequalities in health

Inequalities in Health

Equalities and inequalities in health

Br Med J

Social class mortality differentials: Artefact, selection or life circumstances?

J Epidemiol Commun Health

Disadvantage and mortality: New evidence from the OCPS longitudinal study

Differential Mortality in the U.S.

Cancer mortality by occupation and social class 1851–1971

Social class inequality in mortality from 1921 to 1972 in England and Wales

Popul Stud