ArticleInternational journal for equity in health2020
Intersectional equity in health care: assessing complex inequities in primary and secondary care utilization by gender and education in northern Sweden.
Article in International journal for equity in health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Explaining inequity in knowledge, attitude, and services related to HIV/AIDS: a systematic review.BMC public health · 2024Pooled it
- Mapping the evidence on the intersection of gender and social determinants of health in health inequality: a scoping review.BMC public health · 2025Article
- Income-related inequality and horizontal inequity in healthcare utilization under population aging and labor market changes in Japan.International journal for equity in health · 2025Article
- Examining experiences and system impacts of publicly funded episodic virtual care: protocol for a cross-provincial mixed methods study.BMJ open · 2025Article
- Article
- Disparities in fruit and vegetable intake at the intersection of gender and education in northern Sweden: a cross-sectional study.BMC nutrition · 2022Article
- Research on the Equity and Optimal Allocation of Basic Medical Services in Guangzhou in the Context of COVID-19.International journal of environmental research and public health · 2022Article
- Assessing equity and quality indicators for older people - Adaptation and validation of the Assessing Care of Vulnerable Elders (ACOVE) checklist for the Portuguese care context.BMC geriatrics · 2022Review
- Equilibrium of Tiered Healthcare Resources during the COVID-19 Pandemic in China: A Case Study of Taiyuan, Shanxi Province.International journal of environmental research and public health · 2022Article
- Do changes in primary care service use over time differ by neighbourhood income? Population-based longitudinal study in British Columbia, Canada.International journal for equity in health · 2022Article
- Diversity-sensitive measures in German hospitals - attitudes, implementation, and barriers according to administration managers.BMC health services research · 2022Article
- Inequality and Inequity in Outpatient Care Utilization in Ethiopia: A Decomposition Analysis of Ethiopian National Health Accounts.ClinicoEconomics and outcomes research : CEOR · 2021Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundKnowledge remains scarce about inequities in health care utilization between groups defined, not only by single, but by multiple and intersecting social categories. This study aims to estimate intersectional horizontal inequities in health care utilization by gender and educational level in Northern Sweden, applying a novel methodological approach.
methodsData on participants (N = 22,997) aged 16-84 years from Northern Sweden came from the 2014 Health on Equal Terms cross sectional survey. Primary (general practitioner) and secondary (specialist doctor) health care utilization and health care needs indicators were self-reported, and sociodemographic information came from registers. Four intersectional categories representing high and low educated men, and high and low educated women, were created, to estimate intersectional (joint, referent, and excess) inequalities, and needs-adjusted horizontal inequities in utilization.
resultsJoint inequalities in primary care were large; 8.20 percentage points difference (95%CI: 6.40-9.99) higher utilization among low-educated women than high-educated men. Only the gender referent inequity remained after needs adjustment, with high- (but not low-) educated women utilizing care more frequently than high-educated men (3.66 percentage points difference (95%CI: 2.67-5.25)). In contrast, inequalities in specialist visits were dominated by referent educational inequalities, (5.69 percentage points difference (95%CI: 2.56-6.19), but with no significant horizontal inequity - by gender, education, or their combination - remaining after needs adjustment.
conclusionThis study suggests a complex interaction of gender and educational inequities in access to care in Northern Sweden, with horizontal equity observable for secondary but not primary care. The study thereby illustrates the unique knowledge gained from an intersectional perspective to equity in health care.
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