Access Without Equity: Income-Related Inequities in Preventive Care Across Europe- a cross-sectional study

Background Primary care can reduce avoidable morbidity through prevention, but whether contact with a general practitioner translates into equitable preventive care across Europe remains uncertain. We assessed income-related inequities in general practitioner attendance and preventive care using European Health Interview Survey wave 3 microdata. Methods We conducted a cross-sectional study of 236,309 adults aged 40 years or older from 31 European countries. Socioeconomic position was measured using country-specific quintiles of net monthly equivalised household income. Income-related inequity was estimated using the Relative Index of Inequality, ranked from highest to lowest income. Outcomes included general practitioner/family doctor consultation, cardiometabolic measurements, influenza vaccination, colorectal cancer screening, mammography, cervical smear testing and a composite indicator of receiving at least 80% of eligible preventive services. Adjusted Poisson regression models estimated Relative Index of Inequality values. Outcomes were coded as adverse events, so values above one indicate worse outcomes among lower-income individuals. Results General practitioner contact was common: 79.9% of participants reported consultation in the previous year and 45.3% in the previous four weeks. Lower-income adults were more likely to attend primary care; no consultation in the previous four weeks showed an inverse gradient (Relative Index of Inequality 0.84, 95% confidence interval 0.80–0.88). However, lower-income participants were more likely to receive less than 80% of eligible preventive services (1.10, 1.03–1.18). Inequities were strongest for colorectal screening (1.18, 1.10–1.28), mammography (1.44, 1.30–1.59) and cervical smear testing (1.85, 1.64–2.09). Cardiometabolic measurements showed little income-related gradient. Among participants with recent general practitioner contact, preventive care inequities persisted, especially for cancer screening. Conclusions Across Europe, primary care contact did not ensure equitable preventive care. Strengthening primary care may improve prevention most effectively when investment supports systematic recall, outreach, clinical prompts and integration with organised screening programmes, rather than simply increasing contact with services.