Is geographical distance a barrier in the use of public primary health services among rural and urban young adults? Experience from Northern Finland.

ABSTRACT

OBJECTIVES: To study the role of distance in public primary health service use in rural and urban local residential areas (1 km² grids) among the young adults of the Northern Finland Birth Cohort 1966 (N = 4503). STUDY DESIGN: Cross-sectional study of a cohort born in Northern Finland in 1966. METHODS: Use of local health centres was surveyed by postal questionnaire in 1997, and distance from study subjects' home to health centre was calculated along road network. The crude and adjusted incidence rate ratios (IRR) and their 95% confidence intervals were calculated for distance, predisposing and illness-level variables. Distance-related health inequity indices were calculated. RESULTS: The IRRs indicated 1.5-fold higher rate of health centre visits among subjects living farther than 10 km compared to subjects living within 2 km from health centre in urban areas. In rural areas, IRRs indicated no significant association with distance and health centre use. No distance-related inequity in the use of health centre services was found. CONCLUSIONS: Distance does not seem to be major barrier in health service use among these 31-year old adults. However, closer study of some groups, such as the rural unemployed, might be valuable.