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Social fragility: a key determinant in health inequalities

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Author(s): Saas C | Moulin JJ | Labbe E | Chatain C | Gerbaud L

Journal: Pratiques et organisation des soins
ISSN 1952-9201

Volume: 38;
Issue: 2;
Start page: 139;
Date: 2007;
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Keywords: educational status | social class | occupation | health | self rated health | socioeconomic status | deprivation | vulnerable populations

ABSTRACT
Aim: Socio-economic characteristics (socio-professional category, level of education, income) are the traditional determinants of health-related social inequalities. The objective of this study is to show that social fragility, as measured by a single score, is also a key determinant of health inequalities.Methods: The study population was composed of 87 733 men and 89 724 women examined in 2002 in Health Examination Centres funded by the French national health insurance system. Socio-economic indicators are the level of education and socio-professional category (SPC). Social fragility is measured by an individual score (EPICES), based on 11 binary questions on the material and social determinants of deprivation. The health indicator used is perceived health, measured on a scale running from zero to ten and split into two classes. The relative risks are estimated by odds ratios (OR) from multivariate logistic regressions.Results: Each indicator is significantly associated with a negative health perception: the OR are 1.66 [1.64; 1.67] and 1.66 [1.64; 1.68] for social fragility, 1.50 [1.48; 1.51] and 1.40 [1.39; 1.42] for the level of education and 1.34 [1.32; 1.35] and 1.44 [1.42; 1.46] for the SPC in women and men, respectively. The multivariate analysis shows that the social fragility score explains 50 % to 61 % of links between the SPC, the level of education and negative perception of health. On the other hand, the level of education and SPC only explain 9%to 18%of links between social fragility and perceived health.Conclusion: Our results show that social fragility, measured by the EPICES score, appears to be a key determinant of the negative perception of health, independent of traditional socio-economic indicators.
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