Inequalities in income and long term disability in Spain: analysis of recent hypotheses using cross sectional study based on individual data

Abstract

Objective: To compare the relation between inequalities in long term disability and income in the 17 regions of Spain.

Design: Data were taken from the survey on impairments, disabilities, and handicaps that was carried out in Spain in 1986. For each region the inequality in long term disability associated with income was calculated as the odds ratio associated with reducing monthly household income by 10 000 pesetas (about £50) (estimate of effect of inequality of income) and the odds ratio for the inequality in long term disability between those at the bottom and those at the top of the income hierarchy (relative index of inequality).

Main outcome measure: Prevalence of long term disability.

Results: Five of the eight regions where lowering income had a greater effect on long term disability were among those with the lowest 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 inequality had the highest estimate of effect, and another three regions with the lowest estimate of relative index of inequality had the lowest estimate 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 have a negligible effect on health in countries with high socioeconomic development. However, inequality in income distribution did not determine inequality in health between those at the bottom and those at the top of the income hierarchy in many Spanish regions.