Ignoring social factors in clinical decision rules: a contribution to health inequalities?

Much work has been published on health inequalities and the health-care system. Ignoring the fact that it is risky to summarize a literature review in a single sentence, I would suggest that most publications on this subject have focused on the conditions of primary access to care. Far fewer papers have investigated the next step: what happens when patients have had a first contact with the health-care system. While data are more sparse, they are, however, concordant: entering the health-care system does not mean that each person will receive the same care and/or the same quality of care for a given disease. Social differences in delivery of preventive services, frequency of negative health effects or quality of disease control under treatment have been reported.1 Whether primary or secondary access to care is concerned, the hypothesis is, however, that the same medical decision rules should apply to all patients, whatever … * Correspondence: Thierry Lang, Laboratoire d'Epidemiologie et de Sante Publique, INSERM U558, IFR 126 Sante Societe, Faculte de Medecine, 37 allees Jules Guesde, 31073 Toulouse Cedex, France, tel: +33 5 61 14 59 35, fax: +33 5 62 26 42 40, e-mail: lang{at}cict.fr