Country of birth and socioeconomic disparities in utilisation of health care and disability pensions - a multilevel approach

Research output: ThesisDoctoral Thesis (compilation)

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Besides individual characteristics, people born in the same country may present a related pattern of health status and health care utilisation, perhaps because they share a number of socioeconomic and cultural characteristics in addition to their common geographic origin and language. Rather than using simple ethnical or geographical categories, we apply multilevel regression analysis with individuals nested within countries of birth. By this innovative approach the present thesis investigates socioeconomic differences in health care utilisation and disability pensions in the city of Malmö, Sweden, and the role country of birth plays in this context. It is based on the Register for Resource Allocation (1999 and 2003).

Independently of individual socioeconomic characteristics, this thesis identifies a contextual phenomenon related to country of birth that conditions individual health care utilisation and receiving a disability pension. Among other findings we observed that men of low income and those from countries with low economies showed greater total health care utilisation than those with high incomes or who were born in countries with high incomes. However, those individuals presented a lower health care utilisation of private health care providers.

Low educational achievement and living alone were associated with a higher likelihood of receiving a disability pension. Individuals from middle income countries also had a greater chance of receiving a disability pension. Interestingly, country of birth modifies individual level socioeconomic associations.

The country of one's birth appears to play a significant role in understanding how individual socioeconomic differences bear on the likelihood of utilising health care services and of receiving a disability pension.
Original languageEnglish
Awarding Institution
  • Family Medicine and Community Medicine
  • Merlo, Juan, Supervisor
Award date2005 Dec 16
ISBN (Print)91-85481-11-4
Publication statusPublished - 2005

Bibliographical note

Defence details

Date: 2005-12-16
Time: 13:00
Place: Aulan, Medicinskt forskningscentrum, ingång 59, Universitetssjukhuset MAS, Malmö

External reviewer(s)

Name: Svanström, Leif
Title: Professor
Affiliation: Karolinska institutet


<div class="article_info">A Beckman, J Merlo, JW Lynch, UG Gerdtham, M Lindström and T Lithman. <span class="article_issue_date">2004</span>. <span class="article_title">Country of birth, socioeconomic position, and healthcare expenditure: a multilevel analysis of Malmö, Sweden.</span> <span class="journal_series_title">J Epidemiol Community Health.</span>, <span class="journal_volume">vol 58</span> <span class="journal_pages">pp 145-9</span>.</div>
<div class="article_info">A Beckman, A Håkansson, L Råstam, B Chaix, U Gerdtham and J Merlo. <span class="article_issue_date"></span>. <span class="article_title">Country of birth economic characteristics and individual inequities in health care utilisation - a multilevel analysis of the choice of providers in the city of Malmö, Sweden.</span> (submitted)</div>
<div class="article_info">A Beckman, A Håkansson, L Råstam, T Lithman and J Merlo. <span class="article_issue_date"></span>. <span class="article_title">The role country of birth plays in receiving disability pensions in relation to patterns of health care utilisation and socioeconomic differences: a multilevel analysis of Malmö, Sweden.</span> (submitted)</div>
<div class="article_info">J Merlo, B Chaix, H Ohlsson, A Beckman, K Johnell, P Hjerpe, L Råstam and K Larsen. <span class="article_issue_date"></span>. <span class="article_title">A brief conceptual tutorial of multilevel analysis in social epidemiology - using measures of clustering in multilevel logistic regression to investigate contextual phenomena.</span> <span class="journal_series_title">J Epidemiol Community Health</span>, (accepted)</div>

Subject classification (UKÄ)

  • Public Health, Global Health, Social Medicine and Epidemiology

Free keywords

  • Disability pension
  • Utilisation of health care
  • Country of birth
  • Socioeconomic
  • Multilevel
  • Public health
  • medical training
  • General practice
  • epidemiologi
  • medicinsk utbildning
  • epidemiology
  • Folkhälsa
  • Allmän medicinsk utövning


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