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Geography and Socioeconomic Status in Medical Care

Geography and Socioeconomic Status in Medical Care - Comber...

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RESEARCH Open Access A spatial analysis of variations in health access: linking geography, socio-economic status and access perceptions Alexis J Comber 1* , Chris Brunsdon 2 and Robert Radburn 3 Abstract Background: This paper analyses the relationship between public perceptions of access to general practitioners (GPs) surgeries and hospitals against health status, car ownership and geographic distance. In so doing it explores the different dimensions associated with facility access and accessibility. Methods: Data on difficulties experienced in accessing health services, respondent health status and car ownership were collected through an attitudes survey. Road distances to the nearest service were calculated for each respondent using a GIS. Difficulty was related to geographic distance, health status and car ownership using logistic generalized linear models. A Geographically Weighted Regression (GWR) was used to explore the spatial non-stationarity in the results. Results: Respondent long term illness, reported bad health and non-car ownership were found to be significant predictors of difficulty in accessing GPs and hospitals. Geographic distance was not a significant predictor of difficulty in accessing hospitals but was for GPs. GWR identified the spatial (local) variation in these global relationships indicating locations where the predictive strength of the independent variables was higher or lower than the global trend. The impacts of bad health and non-car ownership on the difficulties experienced in accessing health services varied spatially across the study area, whilst the impacts of geographic distance did not. Conclusions: Difficulty in accessing different health facilities was found to be significantly related to health status and car ownership, whilst the impact of geographic distance depends on the service in question. GWR showed how these relationships were varied across the study area. This study demonstrates that the notion of access is a multi-dimensional concept, whose composition varies with location, according to the facility being considered and the health and socio-economic status of the individual concerned. Keywords: Accessibility, Geographically Weighted Regression 1. Introduction The subject of health facility access has long been of concern to community and public health planners [1-4]. Previous research on public health access has been in two distinct and usually non-overlapping areas. One tranche has considered the spatial dimensions related to geographic access (distances, travel times, catchments, etc), with data being manipulated and geographically analysed using geographical information systems (GIS) before subsequent statistical analyses [5-8]. Another body of research has examined service accessibility by considering the socio-economic aspects of access related to cost, insurance provision etc, with data collected using opinion or attitudes surveys [9-13]. In both cases the objective is usually to inform spatial planning and health policy making. This paper presents an analysis
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