Socioeconomic differences in general practice consultation rates in patients aged 65 and over: prospective cohort

Objective To examine socioeconomic differences in general practice consultation rates among patients aged 65 years and over. Design Secondary anal,sis of data from the fourth national survey of morbidity in general practice. Setting 60 general practices in England and Wales. Subjects 71 984 people aged 65 years and over. Main outcome measures Annual contract rates and home visiting rates with general practitioners and practice nurses. Results Social class differences in contact rates were greatest in 65-74 year olds, with rates 23% higher in patients from social class V than in class I (4.82 v 3.93 per person). In 75-84 year olds there was no clear association between social class and contact rates, and in people aged greater than or equal to 85 years contact rates were highest in patients from class I. Home visiting rates were twice as high in patients from class V as in patients from class I (1.38 v 0.66 per person). Contact rates were 17% higher in people living in communal establishments and 8% higher in those living alone than in those living with others but not in a communal establishment. 16% of contacts with patients in communal establishments and 26% of those with patients living alone were in patients' homes compared with 18% with those living in standard accommodation. These differences persisted after adjustment in a generalised linear model. Conclusions Elderly people show socioeconomic differences in consultation rates. The extra workload generated by elderly people living alone and in communal establishments suggests additional payments to general practitioners are needed.