Socio-economic inequalities in utilisation of physiotherapy and chiropractic treatment in Norway. A population based cross-sectional survey

Abstract

Background: In Norway, it is widely agreed that health services should be available for all, irrespective of place of residence, gender, income or socioeconomic status. It seems that the use of general practitioners is equally distributed, while the better-off are more likely to use specialist healthcare. There is limited knowledge of the equity of other aspects of health care, such as physiotherapy and chiropractic care. Aim: The aim of this thesis is to investigate socioeconomic differences in the utilization of physiotherapy and chiropractic treatment. Methods and materials: The material used for this thesis is comprised of questionnaire data from the sixth survey of the cross – sectional Tromsø Study, conducted in 2007 - 08. The study sample consists of 12,984 participants aged 30-87 years. Descriptive analysis was used to describe the study population. To investigate associations between household income, education and the utilization of physiotherapy and chiropractic treatment, logistic hierarchical regressions were conducted. The outcome variable is probability of use of physiotherapy and chiropractic treatment during the previous 12 months. Analyses were stratified by gender and adjusted for age and a selection of need variables. Results: Need factors are the most important predictor for use of physiotherapy and chiropractic treatment. Women’s probability of visiting a physiotherapist increases with increasing education (OR for trend 1.118, CI 1.018 – 1.228). In men, high income predicts higher probability of use of physiotherapy (OR for trend 1.258, CI 1.138 – 1.391). Both in men and women, the probability of using a chiropractor increased with increasing income (OR for trend 0.860, CI 0.788 – 0.951 and 0.898, CI 0.817 – 0.987 respectively). Men with the highest income were more than two times more likely to use both physiotherapy and chiropractic treatment than men with the lowest income. Conclusion: This thesis reveals inequalities in the use of chiropractic treatment and physiotherapy according to income and education.