SOCIAL INEQUALITIES AND HEALTH-STATUS IN WESTERN GERMANY

Study Objective: To examine social class gradients for seven self-repo rted diseases in western Germany. Design: A pooled analysis of three c ross-sectional representative health surveys in western Germany and th ree health surveys in the six intervention regions of the German Cardi ovascular Prevention Study. Participants: 44,363 study subjects, of bo th sexes, with German nationality, aged 25-69 years, were examined in the national and regional health surveys from 1984 to 1991. Measuremen t and main results: Assessment of disease prevalence was carried out b y a standardized self-administered questionnaire. Social class was ass essed using a composite index combining educational achievement, occup ational status and household income. Cigarette smoking and Pattern A b ehaviour were based on self-report. Height and weight were measured by physical examination and body mass index was calculated. Statistical analysis were performed using multiple logistical regression. Response rates ranged from 66.0 to 71.4% in the national surveys and from 65.9 to 83.8% in the regional surveys. For both sexes, the prevalence of p revious myocardial infarction and the prevalence of stroke, diabetes m ellitus and chronic bronchitis was significantly higher in the lower s ocial classes. In males only, the prevalence of intervertebral disc da mage and peptic ulcer was significantly higher in the lower social cla sses. In females only, there was a similar gradient for hyperuricaemia and gout. In both sexes, allergies and hay fever were the only diseas es with higher prevalence in the higher social classes. Adjusting thes e trends for smoking, obesity and Pattern A behaviour resulted in only minor changes in the slopes of the disease-specific social class grad ients. Conclusion: In western Germany, despite a health system with al most free access for the general population, strong social class inequ alities exist for many diseases. These inequalities cannot be explaine d by social class differences in smoking, obesity or Pattern A behavio ur. More research is needed to identify underlying causes for these pe rsistent social inequalities in health status.