Determinants of perceived health and unmet healthcare needs in universal healthcare systems with high gender equality

Christina P Tadiri,Teresa Gisinger,Karolina Kublickiene,Alexandra Kautzky-Willer,Valeria Raparelli,Louise Pilote,Colleen M Norris,Maria Trinidad Herrero

doi:10.1186/s12889-021-11531-z

Abstract

BackgroundPatient attitudes about health and healthcare have emerged as important outcomes to assess in clinical studies. Gender is increasingly recognized as an intersectional social construct that may influence health. Our objective was to determine potential sex differences in self-reported overall health and access to healthcare and whether those differences are influenced by individual social factors in two relatively similar countries.MethodsTwo public health surveys from countries with high gender equality (measured by UN GII) and universal healthcare systems, Canada (CCHS2014, n = 57,041) and Austria (AT-HIS2014, n = 15,212), were analysed. Perceived health was assessed on a scale of 1 (very bad) to 4 (very good) and perceived unmet healthcare needs was reported as a dichotomous variable (yes/no). Interactions between sex and social determinants (i.e. employment, education level, immigration and marital status) on outcomes were analysed.ResultsIndividuals in both countries reported high perceived health (Scoring > 2, 85.0% in Canada, 79.9% in Austria) and a low percentage reported unmet healthcare needs (4.6% in Canada, 10.7% in Austria). In both countries, sex and several social factors were associated with high perceived health, and a sex-by-marital status interaction was observed, with a greater negative impact of divorce for men. Female sex was positively associated with unmet care needs in both countries, and sex-by-social factors interactions were only detected in Canada.ConclusionsThe intersection of sex and social factors in influencing patient-relevant outcomes varies even among countries with similar healthcare and high gender equality.

Highlights

Patient attitudes about health and healthcare have emerged as important outcomes to assess in clinical studies
A total of 25,044 men and 31,997 women were included in Canadian Community Health Survey (CCHS) and a total of 6713 men and 8499 women were included in Austrian Health Information Survey (AT-HIS)
The distribution of income differed between countries, with more Canadians being classified as middle income (49.5% versus 21% in Austria) and more Austrians being classified as high income (44% versus 24.1% in Canada)

Summary

Introduction

Patient attitudes about health and healthcare have emerged as important outcomes to assess in clinical studies. Our objective was to determine potential sex differences in self-reported overall health and access to healthcare and whether those differences are influenced by individual social factors in two relatively similar countries. Social determinants may impact an individual’s ability to access nutritious food and healthcare resources, time and space for physical activity [1, 2] as well as an individual’s mental health through chronic financial or psychosocial stress [3], which may influence an individual’s overall perception of their health. Conceptions of gender often vary over time and with culture, as may their influence on health and few studies have examined the intersection of sex, and social determinants of health across countries to incorporate this cultural impact

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