RESPIRATORY SYMPTOMS, LUNG-FUNCTION AND USE OF HEALTH-SERVICES AMONG UNEMPLOYED YOUNG-ADULTS IN SPAIN

The association of respiratory symptoms, lung function and use of heal th services with employment status was examined in Spain, a country wi th a high rate of unemployment, A population sample comprising 179 une mployed and 1.868 employed subjects aged 20-44 yrs in 1993, was random ly selected from a base population of about 170,000 people in five urb an and rural areas of Spain. Subjects completed a questionnaire on res piratory symptoms, sociodemographic and lifestyle factors, occupationa l exposure and use of health services, and performed a forced spiromet ry, a methacholine challenge test and blood tests, Unemployed subjects had a higher risk of simple chronic bronchitis (odds ratio=2.06, 95% confidence interval 1.30-3.24) and of bronchitis-type symptoms, than t hose who were employed. These risks were, in part, due to the higher p revalence of smoking, poorer housing and prior occupational exposures among unemployed than among employed people. Smaller differences were found between employed and unemployed subjects for asthma-type symptom s, atopia and lung function tests, Use of health services among subjec ts with respiratory symptoms was similar among employed and unemployed subjects, except that the latter consistently reported less frequent contact with specialized practitioners, Unemployed subjects had a high er risk of bronchitis-type symptoms than employed subjects. In Spain's national, free-access healthcare system, the differential use of spec ialized health services by employment status is likely to imply differ ences in the characteristics of the healthcare provided.