INEQUALITIES IN INCOME AND LONG-TERM DISABILITY IN SPAIN - ANALYSIS OF RECENT HYPOTHESES USING CROSS-SECTIONAL STUDY BASED ON INDIVIDUAL DATA

Objective: To compare the relation between inequalities in long term d isability and income in the 17 regions of Spain. Design: Data were tak en from the survey on impairments, disabilities, and handicaps that wa s carried out in Spain in 1986. For each region the inequality in long term disability associated with income was calculated as the odds rat io associated with reducing monthly household income by 10 000 pesetas (about pound 50) (estimate of effect of inequality of income) and the odds ratio for the inequality in long term disability between those a t the bottom and those at die top of the income hierarchy (relative in dex of inequality). Main outcome measure: Prevalence of long term disa bility. Results: Five of the eight regions where lowering income had a greater effect on long term disability were among those with the lowe st income per head, while six of the remaining nine regions where the effect was smaller were among those with the highest income per head. Three regions with the highest estimate of relative index of inequalit y had the highest estimate of effect, and another three regions with t he lowest estimate of relative index of inequality had the lowest esti mate of effect. In contrast the relative position of the remaining 11 regions varied from one measure to another. Conclusions: These results support the theory that additional increments in material wellbeing h ave a negligible effect on health in countries with high socioeconomic development. However, inequality in income distribution did not deter mine inequality in health between those at the bottom and those at the top of the income hierarchy in many Spanish regions.