Katharina Viktoria Stein

Access points to the different levels of health care and demographic predictors in a country without a gatekeeping system. Results of a cross-sectional study from Austria.

BACKGROUND The challenges for health care systems are evident both in terms of costs and of healthy life expectancy. It was the aim of this study to assess the access points towards the different levels of care and predictors for consulting a specialist without having consulted a general practitioner (GP), a common way of access to the Austrian health care system, a system without gatekeeping function. METHOD The database used for this analysis was the Austrian Health Interview Survey 2006-07, with data from 15 474 people. Statistical analyses included descriptive statistics as well as multivariate logistic regression models. RESULTS In the 12 months before the survey, 78.8% consulted a GP, 67.4% consulted a specialist, 18.6% visited an outpatient department and 22.8% had a hospital stay at least once. Overall, 15.1% visited a specialist, 8.5% an outpatient department and 8.1% a hospital without consulting a GP concomitantly. One of the main reasons for direct specialist use was a preventive check-up visit. Tertiary education and migration background increased significantly the chance of having been to a specialist without GP contact for both sexes. CONCLUSION The overall access rates for specialists as well as the access rates for specialist without GP consultations were high. The findings point into the direction of a benefit through a structurally supported advocacy role for primary health care professionals. The knowledge gained could contribute to the health policy debate on the importance of coordination and continuity with special respect to demographic factors showing the importance of target-group-specific interventions.

Sickness absence due to back pain or depressive episode and the risk of all-cause and diagnosis-specific disability pension: A Swedish cohort study of 4,823,069 individuals

The aim of this study was to investigate the associations between sickness absence due to back pain or depressive episode with future all‐cause and diagnosis‐specific disability pension, while adjusting for comorbidity and socio‐demographics, for all and stratifying for sex.

East-West gradient in cardio-vascular mortality in Austria: how much can we explain by following the pattern of risk factors?

BackgroundVarious studies show major regional differences in the prevalence of cardio-vascular disease morbidity and mortality, both in Europe and within European countries. In Austria, these differences are documented by an East-West gradient with declining morbidity and mortality rates when moving from the East to the West of the country. It was the aim of this study to analyse if, and to what extent, socio-demographic and socio-economic determinants, social resources and health behaviour can contribute to the clarification of this East-West gradient by conducting secondary analyses of an existing Austrian health dataset.ResultsThe data were analysed using bivariate analyses, as well as univariate and multivariate logistic regression models. These analyses revealed significant East-West gradients for various risk factors, as well as socio-demographic and socio-economic health determinants. There was a gradual decrease of hypertension, diabetes mellitus, obesity, and psycho-social discomfort in both sexes, with the highest prevalences in those Austrian regions with the highest cardio-vascular mortality and a stepwise decrease to the regions with the lowest cardio-vascular mortality. Controlling for educational level significantly raised the odds for diabetes, hypertension and obesity. In the results of the multivariate analyses, factors that significantly and independently predicted diabetes mellitus were geographic location, psycho-social discomfort, lack of physical exercise, and age in both sexes. For women these factors additionally included a low educational level, lack of social support, and being born abroad.ConclusionsOur study shows a clear gradual decline of cardio-vascular mortality and some of its risk factors from East to West in Austria. Concerning these risk factors, the geographic region and psycho-social discomfort showed the greatest association with diabetes mellitus, hypertension, and obesity. Hence, they contribute to the explanation of the variance in spatial cardio-vascular disease mortality. Yet, a large proportion of this variance remains unexplained. It would be of great importance to public health and preventive measures to take a closer look at spatial differences in cardio-vascular disease morbidity and mortality to better tailor programmes to the regional environments and settings. Our results also call for a greater importance of preventative measures for psycho-social discomfort and increase of social support.

Coverage of recommended vaccinations in subjects with diabetes mellitus and ischemic heart disease: results for women and men

ZusammenfassungImpfungen sind wichtige Public Health Strategien, um in der Allgemeinbevölkerung und bei Personen mit chronischen Erkrankungen Präventionsmaßnahmen zu setzen. Es war das Ziel dieser Analyse, die Durchimpfungsrate mit empfohlenen Impfungen bei Männern und Frauen mit Diabetes mellitus und nach einem Myokardinfarkt (MI) zu erheben und Trends anhand von drei Interviewsurveys (1991, 1999 und 2006/07) zu analysieren. Die Ergebnisse zeigen einen Anstieg in der selbst berichteten Influenzadurchimpfungsrate sowohl in der Allgemeinbevölkerung als auch bei Hochrisikogruppen, allerdings sind die Durchimpfungsraten in allen analysierten Subpopulationen äußerst niedrig. Obwohl in früheren Untersuchungen Frauen höhere Influenzadurchimpfungsraten zeigten als Männer, war in der rezentesten Befragung diesbezüglich eine Trendwende zu verzeichnen. Im Survey 2006/07 hatten Männer mit Diabetes oder nach MI eine höhere Wahrscheinlichkeit gegen Influenza geimpft zu sein als Männer ohne diese Erkrankungen (altersadjustierte OR: 1,61; 95 % CI: 1,29–1,99 bzw. 1,61; 95 % CI: 1,21–2,15), bei Frauen war dies jedoch nicht der Fall (OR: 1,10; 95 % CI: 0,89–1,35 bzw. 0,87; 95 % CI: 0,58–1,33). Weder Männer noch Frauen mit Diabetes mellitus oder MI hatten eine signifikant höhere Wahrscheinlichkeit gegen Pneumokokken geimpft zu sein verglichen mit Personen ohne diese Erkrankungen. Die beobachteten geschlechtsspezifischen Unterschiede erfordern weitere Forschung bezüglich der zugrundeliegenden Ursachen. Strategien, höhere Durchimpfungsraten bei Männern und Frauen zu erreichen, sind nötig.SummaryVaccination is an important public health strategy to prevent adverse health outcomes in the general population and in subjects with chronic diseases. It was the aim of this study to compare data on coverage of recommended vaccinations in men and women with diabetes mellitus and after myocardial infarction (MI) and to analyse trends in three different interview surveys: 1991, 1999 and 2006–07. The data show a rise in influenza vaccination coverage rate in men and women in the general population and in high-risk groups. However, coverage rates in all analysed groups were still strikingly low. Although in soft reported earlier surveys women were vaccinated more often than men, there was a reverse trend observed in the most recent survey. In the survey of 2006–07, men with diabetes or after MI had a higher chance of being vaccinated against influenza when compared to men without these diseases (age adjusted OR: 1.61; 95% CI: 1.29–1.99 and 1.61; 95% CI: 1.21–2.15, respectively). This was, however, not the case in women (OR: 1.10; 95% CI: 0.89–1.35 and 0.87; 95% CI: 0.58–1.33, respectively). Neither men nor women with diabetes mellitus or MI had a significantly higher chance of having pneumococcal vaccination when compared to subjects without these diseases. The observed sex-specific differences demand more research regarding the underlying causes. Strategies to reach higher vaccination coverage in men and women are needed.

Individual Cognitive Social Capital and Its Relationship with Pain and Sick Leave Due to Pain in the Austrian Population.

Background Individual cognitive social capital has repeatedly been shown to be linked to health disparities in many dimensions. The aim of the study was to investigate the association between social capital and pain-related measures. Methods 15,474 subjects older than 15 years were personally interviewed on subjective health, quality of life, health behaviour, and utilisation of healthcare in the Austrian Health Interview Survey. An indicator for cognitive social capital at the individual level consisting of nine questions targeted at different social resources was built and its association with pain-related items analysed. Results Odds ratios, adjusted for age, chronic diseases, and educational level for having suffered from severe pain in the last 12 months were 2.02 (95% CI 1.77–2.03) in the lowest tertile and 1.30 (95% CI 1.14–1.47) in the middle tertile of social capital for men. The corresponding odds ratios for women were 2.28 (95% CI 2.01–2.59) and 1.30 (95% CI 1.15–1.46). In both sexes, pain intensity increased significantly with decreasing level of social capital. The proportion of subjects that have been on sick leave in the last 12 months due to pain were 16.3%, 12.0%, and 7.7% (P<0.001) from lowest to highest tertile of social capital in men, and 16.5%, 12.3%, and 6.7%, respectively (P<0.001) in women. Conclusion Our findings indicate that low cognitive social capital at individual level is significantly associated not only with higher prevalence of pain and higher pain intensity, but also with a higher chance for sick leave due to pain in employed subjects.