Regional variations in the development of illness in Finland

The aim of the present study is to investigate the incidence of morbidity leading to incapacity for work in the working age population of Finland, and to examine critically the development of such illness and variations between different population groups. An attempt is made to analyse to what extent regional differences in illness development are connected with the communal structure of an area and the provision and use of medical services. The material is based on data from the sickness insurance and national penisons, and mortality statistics. The variables used as those defined by Kalimo (1967; 1968) to describe the various features of community structure and the supply of medical services, and data from the insurance and hospital service statistics to measure the use of medical services. The results indicate considerable variation in the course of illnesses between population groups, as expressed as the incidence rates for the various phases of illness or as development probabilities. Illness development proved to be more unfavourable in men than in women. Large regional differences were found, with the course of illnesses appearing to be much more unfavourable in the eastern and northern parts of Finland than in the south and south west. This seems to be closely connected with poorer socioeconomic development and lower urbanization in an area. A clear correlation was found between illness development and the supply and use of medical services in ambulatory care. Illness development was particularly unfavourable in areas where the supply and use of ambulatory medical services, especially doctors' services, were poor. No corresponding correlation was found with the supply and use of hospital services. Development of sickness proved to be connected with a neglect of illnesses at an early phase and delay in seeking medical care. The result is confirmed by variations between population groups in the numbers of sickness benefits awarded. It was confirmed that morbidity resulting in incapacity for work is closely associated with local socioeconomic development.