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Background: Earlier studies on gender and socioeconomic differences in the treatment of coronary heart disease have focused mainly on structural features of the health-care system on the one hand and on coronary patients' psychosocial characteristics on the other. The aim of this exploratory qualitative study was to trace key points in the pathways of treatment where patients' experience varies and which can contribute to gender and socioeconomic differences in treatment., Methods: The data consist of 30 interviews among persons diagnosed with or suspected to have coronary heart disease in the Health 2000, a representative cross-sectional interview and health examination survey. Purposive sampling was used to ensure variation in gender, socioeconomic status and disease severity. The data were analysed using qualitative content analysis., Results: Gender and socioeconomic differences were found in two key points in the pathways of treatment: doctor-patient interaction and the organization of primary care. The three features commonly distinguished in doctor-patient interaction, i.e. treatment decision-making, information exchange and interpersonal relationship, were all found to be relevant. A second key point was organization of primary care in terms of both access to examinations and care, and continuity of care., Conclusions: These results should sensitize us to gender and socioeconomic differences in coronary patients' problems in access to and continuity of care, as well as to potential problem areas in doctor-patient interaction.

Objective: We examined socioeconomic disparities in coronary procedure rates after first events among hospitalized myocardial infarction (MI) patients., Study Design and Setting: Information on MI patients in 1995 in Finland was obtained from the Finnish Cardiovascular Disease Register Project. Data on comorbidity, invasive treatments, hospitalizations, mortality, and socioeconomic status were obtained by linking data from the Finnish Hospital Discharge Register, cause of death register, population census, and the health insurance register using personal identity numbers., Results: In 1995, 5172 patients aged 40 to 74 years were hospitalized for first MI. This corresponds to age-standardized event rates of 354/100,000 for men and 152/100,000 for women. Within 2 years, 33% of men and 21% of women underwent an invasive coronary procedure. Men in the lowest income third underwent 25% (95% confidence interval [CI] 12-36) fewer procedures than men in the highest third. Among women, the corresponding difference was 43% (95% CI 24-57). These disparities persisted throughout the 2-year follow-up, and they were not reduced by adjustment for comorbidity or hospital district., Conclusion: Socioeconomic disparities were observed in receipt of invasive cardiac procedures. More attention should be paid to equitable distribution of scarce health care resources.

Background: This paper seeks to examine changes in health inequalities in Finland from the mid-1980s to the mid-1990s. To improve our understanding of the contribution of employment status changes to class and educational differences in health within the context of changing labour market conditions, we examined the differences in ill health among social classes, educational groups, and employment status groups., Methods: The data was derived from nation-wide Finnish Surveys on Living Conditions from 1986 and 1994. Analyses included the age range 25-64 years. Health was measured using limiting long-standing illness and perceived health as below good. Results are presented as age-standardized prevalence percentages and odds ratios from logistic regression analyses., Results: The pattern and size of relative social inequalities in ill health have remained generally stable during the eight-year study period in Finland. Differences between social classes have changed only slightly. Differences between educational groups have declined somewhat among men, but have remained stable among women. Compared with the employed, health among the unemployed, housewives, and pensioners has improved for both men and women. Analysing social class differences within both the employed and the non-employed showed only negligible changes., Conclusions: Changes in social inequalities in health as indicated by class and educational differentials among Finnish men and women have mostly been negligible. The observed changes are likely to have been affected by the 1990s' labour market crisis in Finland. The rapidly increasing mass unemployment is unlikely to have been very individually selective in the short run. However, in the longer run, to the extent that unemployment remains high, this trend can be expected to change as re-entry to paid employment is likely to be more individually selective.

The Nordic countries, referring here to Denmark, Finland, Norway, and Sweden, have often been viewed as a group of countries with many features in common, such as geographical location, history, culture, religion, language, and economic and political structures. It has also been habitual to refer to a "Nordic model" of welfare states comprising a large public sector, active labour market policies, high costs for social welfare as well as high taxes, and a general commitment to social equality. Recent research suggests that much of this "Nordicness" appears to remain despite the fact that the Nordic countries have experienced quite different changes during the 1980s and 1990s. How this relates to changes in health inequalities is in the focus of this supplement.

The test-retest reliability of self-rated health is analysed and compared with the reliability of health questions phrased more as well as less precisely. Differences in reliability between men and women and between age groups are also assessed. The study is based on 204 and 409 re-interviews from the 1991 Swedish Level of Living Survey and the 1989 Survey of Living Conditions respectively. The results show that the reliability of self-rated health is as good as or even better than that of most of the more specific questions. Only an indicator of high blood pressure showed significantly higher reliability. The reliability of self-rated health is good in all subgroups studied, and is even excellent among older men. It is concluded that the good overall reliability of self-rated health found in this study is in line with previous results concerning the validity of people's assessments of their general health as well as results concerning the basis upon which they make these judgements.

Nationwide surveys from Finland, Norway and Sweden were analysed to examine socioeconomic inequalities in illness. This article first describes differentials in self-reported limiting long-standing illness and its distribution according to educational level. Age-standardized prevalence rates according to education are examined, and top and bottom prevalence ratios are compared between countries and genders. Secondly, the article attempts to assess the 'global' extent of inequalities in illness. This is made by calculating concentration indices for each country and gender. The description shows large illness differentials according to educational level in each country. A similar socio-economic pattern emerges from all three countries and both genders; i.e. lower socio-economic positions are associated with higher illness levels. This pattern is more distinct for men than for women. The gap in illness between top and bottom educational groups is widest for Norwegian men and smallest for Finnish women. However, top and bottom comparisons overlook other than the extreme groups, and give no information on the sizes of the groups. To avoid these problems concentration indices were calculated to assess the extent of inequalities in illness. According to these indices Norwegian men also show the highest extent of inequality, but differences to Swedish and Finnish men are small. The extent of inequality among women is smaller than among men; among Finnish and Norwegian women it is smaller than among their Swedish counterparts. Measures of inequalities such as the concentration index are useful tools, although complex inequalities cannot be captured by single measures. In the assessment of health inequalities not only relative but also absolute differentials need to be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Finland, Norway and Sweden are highly developed welfare states with a long tradition of egalitarian health and welfare policies. This article analyzes social class differentials in self-reported limiting long-standing illness among men and women in these countries. The data consisted of nation-wide Level of Living Surveys made in 1986-87 in Finland (N = 11,783), Norway (N = 4,211) and Sweden (N = 4,699). Women reported both long-standing illness and limiting long-standing illness slightly more often than men. The prevalence of limiting long-standing illness was lower in Sweden than in Finland and Norway. In all countries blue-collar workers reported ill-health more often than white-collar employees. The prevalence of self-reported limiting long-standing illness among Swedish upper white-collar workers was very low and that among Finnish farmers very high. Skilled female workers showed the worst health whereas Swedish upper class men showed the best health. The reasons for these social inequalities, and their implications for social policy, are discussed.

Investigations of living standards in Norway, Sweden and Finland in 1986-1987 yielded new comparative data on public health and disease as related to social class. Long-term troublesome illness was less common in Sweden than in Finland and Norway. In all three countries the jobless category and skilled working women accounted for the highest morbidity. Among men, morbidity was greatest for agricultural workers in Finland and Norway, and lowest for Swedes of social class 1--i.e., highly placed and highly educated white collar workers.