The influence of social and ethnic segmentation on consultation in primary health care

This paper analyses the utilization of primary health care by a population of whom 28% were not born in Sweden. The study emphasizes the impact of demography, housing and economic factors on the structure of the residential area. Households with meagre financial resources, large families and most of the immigrant population were tenants in multiple-occupancy blocks. Further, when demographic development was analysed over a decade, high turnover and a low median age were found in 2 of the multiple-occupancy areas, indicating social instability. The study revealed a process of both socioeconomic and ethnic segmentation (non-spatial segregation in a residential area). The age- and sex-standardized relative risks (RR) showed that the population in subareas consisting of multiple-occupancy housing in socially unstable areas also had an increased risk of having to visit primary health care. There were no differences in the number of visits to primary health care between people born in Sweden and those born outside Sweden (relative risk (RR) = 1.09,95% confidence interval (CI) = 0.90–1.30), but those born outside Sweden more often made visits that lasted longer than 30 minutes (odds ratio (OR) = 3.75, 95% CI = 2.09–6.71).