Die Bedeutung sozialer Determinanten für die Gesundheitsversorgung

Susanne Schnitzer, Universitätsbibliothek Der FU Berlin
2020
The relevance of social determinants in relation to healthcare derives from the postulated objective of health equality. Systematic disparities based on social determinants point to health inequality. The aim of the Habilitation (post-doctoral project) was to contribute to a better understanding and provide new information about social determinants in healthcare. In contrast to current practice in social epidemiology and public health, the study did not focus primarily on vertical determinants
more » ... tical determinants (income, occupation and education status). Instead, an integrated approach was chosen to investigate vertical and horizontal determinants (age, gender, marital status, etc.) equally. Possible explanations of disparities based on social determinants were also discussed. The results were based on a variety of data sources (routine, cohort and survey data). The statistical analyses were performed using binary logistic regressions, trend and cluster analyses, discriminant analyses and various tests (Hosmer-Lemeshow, omnibus tests, interaction terms). In all studies, age proved to be a significant social determinant, reflecting the fact that disease burden increases with age. However, the analyses also draw attention to social connotations of age, e.g. in relation to the discussed "satisfaction paradox", differences in health literacy, and expectations of healthcare (Sections 3.1 and 3.2). "Partnership status" as a horizontal determinant plays a significant role in relation to care dependency (Section 2.2). Older and very old persons who lived with a partner were less likely to be care-dependent compared to persons without a partner. The multivariable analyses suggest that the protective effect of living with a partner can be explained by the support provided in daily life: the risk of falling may be reduced, for example, or mobility increased. No differences between males and females were observed in any of the analyses after adjusting for morbidities, geriatric assessment parameters or subjective health. Analogous to the gende [...]
doi:10.17169/refubium-27474 fatcat:l4czuwhtzzhfnh24tqi5igwpxi