Papers

Socioeconomic and ethnic group differences in self reported health status and use of health services by children and young people in England: cross sectional study

Sonia Saxena, lecturer in primary care, ^a Joseph Eliahoo, statistician, ^a Azeem Majeed, professor. ^b

^a Research and Development Directorate, University College London Hospitals NHS Trust, London NW1 2LT, ^b School of Public Policy, University College London, London WC1H 9QU

Correspondence to: S Saxena
sonia.saxena{at}pcps.ucl.ac.uk

Objectives: To examine whether self reported health status and use of health services varies in children of different social class and ethnic group.
Design: Cross sectional study from the 1999 health survey for England.
Subjects: 6648 children and young adults aged 2-20 years.
Setting: Private households in England.
Main outcome measures: Proportion of children (or their parents) reporting episodes of acute illness in the preceding fortnight and prevalence of self reported longstanding illness. Proportion reporting specific illnesses. Proportion reporting that they had consulted a general practitioner in the preceding fortnight, attended hospital outpatient departments in the three preceding months, or been admitted to hospital in the preceding year.
Results: Large socioeconomic differences were observed between ethnic subgroups; a higher proportion of Afro-Caribbean, Indian, Pakistani, and Bangladeshi children belonged to lower social classes than the general population. The proportion of children and young adults reporting acute illnesses in the preceding two weeks was lower in Bangladeshi and Chinese subgroups (odds ratio 0.41, 95% confidence interval 0.27 to 0.61 and 0.46, 0.28 to 0.77, respectively) than in the general population. Longstanding illnesses was less common in Bangladeshi and Pakistani children (0.52, 0.40 to 0.67 and 0.57, 0.46 to 0.70) than in the general population. Irish and Afro-Caribbean children reported the highest prevalence of asthma (19.5% and 17.7%) and Bangladeshi children the lowest (8.2%). A higher proportion of Afro-Caribbean children reported major injuiries than the general population (11.0% v 10.0%), and children from all Asian subgroups reported fewer major and minor injuries than the general population. Indian and Pakistani children were more likely to have consulted their general practitioner in the preceding fortnight than the general population (1.86, 1.35 to 2.57 and 1.51, 1.13 to 2.01, respectively). Indian, Pakistani, Bangladeshi, and Chinese children were less likely to have attended outpatient departments in the preceding three months. No significant differences were found between ethnic groups in the admission of inpatients to hospitals. Acute and chronic illness were the best predictors of children's use of health services. Social classes did not differ in self reported prevalence of treated infections, major injuries, or minor injuries, and no socioeconomic differences were seen in the use of primary and secondary healthcare services.
Conclusions: Children's use of health services reflected health status rather than ethnic group or socioeconomic status, implying that equity of access has been partly achieved, although reasons why children from ethnic minority groups are able to access primary care but receive less secondary care need to be investigated.

What is already known on this topic Children from lower socioeconomic classes and from Indian ethnic subgroups may make more use of general practitioners' services than other children Afro-Caribbean, Indian, Pakistani, and Bangladeshi children are less likely to be referred to outpatient and inpatient services at hospitals than white children What this study adds Indian, Pakistani, and Bangladeshi children reported less acute and chronic illness, asthma, and injuries than the general population, whereas Afro-Caribbean children reported more Children's self reported health status and use of health services did not vary by social class Indian and Pakistani children make more use of general practitioners' services, but Indian, Pakistani, Bangladeshi, and Chinese children are less likely to be referred to outpatient clinics Self reported health status rather than socioeconomic status or ethnicity is the best predictor of use of primary and secondary services