Meer sociale uitsluiting van chronisch zieken bij een lager inkomen

To determine whether income is connected with the variation in the social exclusion of chronically ill patients.

Design

Descriptive.

Method

In 223 chronically ill patients that had been detected via patients’ associations, general practitioners and outpatient clinics, a structured interview was administered during a home visit 4 times during a period of 7 months (October 2003-April 2004). Due to dropouts, the actual number of patients interviewed at each of the 4 times was 223, 176, 143 and 105, respectively. Social exclusion was measured with the aid of the ‘Autonomy outside the home’ subscale of the ‘Impact on participation and autonomy’ questionnaire. The possible total score varied from 5 (little social exclusion) to 25 (much social exclusion). In order to explain a possible effect of income, various other patient characteristics were added to the analysis model: type of primary disease (rheumatism, multiple sclerosis, pulmonary emphysema, other), duration of the primary disease, comorbidity, educational level, whether or not the patient was employed or engaged in volunteer work, whether or not the patient lived together with a partner, the self-rated health, physical functioning, social functioning, mental functioning, and the subjective pain. The data were analysed by means of multilevel repeated regression analysis.

Results

A low income was associated with social exclusion at all 4 times of measurement. The regression coefficient of income was –1.47 (95 CI: –2.28- –0.65), indicating that the score on the scale for social exclusion decreased by 1.47 for every € 544,– (= 1 × SD) increase in net monthly income. This relationship could not be explained by the other patient characteristics, not even by a low educational level.

Conclusion

The supportive care intended for the prevention of social exclusion of chronically ill patients should be concentrated sufficiently on those who have too little income to organise such care for themselves.

Ned Tijdschr Geneeskd 2005;149:1898-902