Primary healthcare trajectories and life-course disadvantage - a sequence analysis of 13 countries

Abstract Background Regular participation in primary healthcare is important to identify health issues early and receive appropriate treatment when necessary. However, it is well established that not all populations access general care equally, with socioeconomically disadvantaged populations less likely to participate regularly. What is not yet known is what primary healthcare participation looks like in the form of life-course sequences and whether these trajectories differ between birth cohorts, gender, and countries. Additionally, it is unclear how disadvantages across multiple dimensions and the life course (including childhood deprivation, mid-life education, and later-life financial hardships) predict different trajectories of primary healthcare use. This, to our knowledge, is the first study to use sequence analysis to explore differences in primary healthcare trajectories in the general population. Methods We use sequence analysis to (1) illustrate primary healthcare sequences for self-reported blood pressure, blood test, vision, mammography, and gynecological visits, both jointly and separately, and (2) explore their association with a life-course socioeconomic disadvantage score. Results We included 24'899 participants from the Survey of Health, Ageing, and Retirement in Europe (SHARE) with a mean age of 66 years (± 9.7 SD). Preliminary results show that a higher life course disadvantage score was associated with a reduced likelihood of regular primary healthcare uptake across the life course (ages 16 to 65) for all above-mentioned healthcare services. Further analyses of gender, cohort, and country variation are ongoing. Conclusions In Europe, greater life-course socioeconomic disadvantage is associated with primary healthcare trajectories marked by (1) later initiation of regular participation and (2) persistently lower rates of participation throughout early and late adulthood, compared to trajectories among more advantaged groups. Key messages • Life-course socioeconomic disadvantage is linked to delayed and less regular participation in primary healthcare throughout adulthood in Europe. • Understanding life-course trajectories of healthcare use can inform more equitable healthcare policies across diverse socioeconomic groups.