Abstract
The association of respiratory symptoms, lung function and use of health services with employment status was examined in Spain, a country with a high rate of unemployment. A population sample comprising 179 unemployed and 1,868 employed subjects aged 20-44 yrs in 1993, was randomly selected from a base population of about 170,000 people in five urban and rural areas of Spain. Subjects completed a questionnaire on respiratory symptoms, sociodemographic and lifestyle factors, occupational exposure and use of health services, and performed a forced spirometry, a methacholine challenge test and blood tests. Unemployed subjects had a higher risk of simple chronic bronchitis (odds ratio=2.06, 95% confidence interval 1.30-3.24) and of bronchitis-type symptoms, than those who were employed. These risks were, in part, due to the higher prevalence of smoking, poorer housing and prior occupational exposures among unemployed than among employed people. Smaller differences were found between employed and unemployed subjects for asthma-type symptoms, atopia and lung function tests. Use of health services among subjects with respiratory symptoms was similar among employed and unemployed subjects, except that the latter consistently reported less frequent contact with specialized practitioners. Unemployed subjects had a higher risk of bronchitis-type symptoms than employed subjects. In Spain's national, free-access healthcare system, the differential use of specialized health services by employment status is likely to imply differences in the characteristics of the healthcare provided.
