BMJ 1999;318:642-646 ( 6 March )

General Practice

Socioeconomic differences in childhood consultation rates in general practice in England and Wales: prospective cohort study

Sonia Saxena, clinical research fellow, ^a Azeem Majeed, medical epidemiologist, ^b Michael Jones, lecturer in medical statistics. ^c

^a Department of General Practice and Primary Care, St George's Hospital Medical School, London SW17 0RE, ^b Office for National Statistics, London SW1V 2QQ, ^c Cancer and Public Health Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT

Correspondence to: Dr Majeed azeem.majeed{at}ons.gov.uk

Objective: To establish how consultation rates in children for episodes of illness, preventive activities, and home visits vary by social class.
Design: Analysis of prospectively collected data from the fourth national survey of morbidity in general practice, carried out between September 1991 and August 1992.
Setting: 60 general practices in England and Wales.
Subjects: 106 102 children aged 0 to 15 years registered with the participating practices.
Main outcome measures: Mean overall consultation rates for any reason, illness by severity of underlying disease, preventive episodes, home visits, and specific diagnostic category (infections, asthma, and injuries).
Results: Overall consultation rates increased from registrar general's social classes I-II to classes IV-V in a linear pattern (for IV-V v I-II rate ratio 1.18; 95% confidence interval 1.14 to 1.22). Children from social classes IV-V consulted more frequently than children from classes I-II for illnesses (rate ratio 1.23; 1.15 to 1.30), including infections, asthma, and injuries and poisonings. They also had significantly higher consultation rates for minor, moderate, and serious illnesses and higher home visiting rates (rate ratio 2.00; 1.81 to 2.18). Consultations for preventive activities were lower in children from social classes IV-V than in children from social classes I-II (rate ratio 0.95; 0.86 to 1.05).
Conclusions: Childhood consultation rates for episodes of illness increase from social classes I-II through to classes IV-V. The findings on severity of underlying illness suggest the health of children from lower social classes is worse than that of children from higher social classes. These results reinforce the need to identify and target children for preventive health care in their socioeconomic context.

Key messages Childhood consultation rates for episodes of illness, including infections, asthma, and injuries, increase from social classes I-II through to social classes IV-V Children from lower socioeconomic groups make more use of home visits and consult more often for minor and serious illnesses Consultation rates for preventive care are slightly lower in children from social classes IV-V than in children from classes I-II Members of the primary healthcare team should be aware of socioeconomic factors when children are targeted for preventive activities and when health services are planned

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