Trajectories and inequalities in routine healthcare uptake from adolescence to retirement: A sequence analysis across 14 European countries

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BACKGROUND: Regular uptake of routine healthcare services can support disease prevention, early detection, monitoring, and timely treatment. Socioeconomically disadvantaged populations often face barriers to healthcare use. However, little is known about how routine healthcare uptake, and inequalities within it, unfold across the life course, or whether these trajectories differ by gender and birth cohort. METHODS: We used retrospectively collected SHARELIFE data from wave 3 (2008/09) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) (n = 27'960). We constructed annual binary sequences of self-reported regular uptake from ages 16 to 65 for blood pressure measurement, blood tests for sugar or cholesterol, vision checks, mammography, and gynecological visits. We used sequence analysis to identify service-specific clusters of routine healthcare uptake trajectories. We then used multilevel multinomial regression models to examine associations with life-course socioeconomic disadvantage and birth cohort and assessed gender differences where applicable. RESULTS: Regular healthcare uptake generally increased with age across all services. In the pooled analyses, three broad trajectory types were identified across services: low uptake, uptake mainly in later life, and uptake throughout life. Trajectory membership differed by life-course socioeconomic disadvantage, country, and birth cohort, but not meaningfully by gender. Higher life-course socioeconomic disadvantage was associated with lower odds of belonging to high uptake trajectories compared with low uptake trajectories. CONCLUSIONS: Routine healthcare uptake across adulthood followed age-patterned trajectories that varied by socioeconomic disadvantage, birth cohort, and country of residence. These findings suggest that social stratification influences long-term patterns of routine healthcare uptake across the life course and highlight the importance of addressing inequalities in access to and engagement with routine healthcare services.

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