@unpublished{theses_frw3881,
          author = {Anna Harbers},
           title = {Linking health inequalities of outcomes and opportunities: The association between socioeconomic status, health-related quality of life and health care utilisation of Q-fever patients who experience long-term  health consequences},
            year = {2022},
             url = {https://frw.studenttheses.ub.rug.nl/3881/},
        abstract = {Objective. More than ten years after the Dutch Q-fever epidemic (2007-2010), approximately twenty per cent of Q-fever patients still experience consequences. Understanding the long-term health-related quality of life (HRQoL) of socioeconomic status (SES) groups provides insight into health inequalities following Q-fever.

Theory. Based on patient population studies, inequalities of outcomes were expected: patients with lower SES have lower HRQoL than patients with higher SES. In line with Sen?s Capability Approach, SES was seen as a resource to transform capabilities (choices between health care providers) into functionings (getting the necessary health care), and health inequalities in opportunities between SES 
groups were expected. Lastly, health care utilisation was expected to mediate the association between SES and HRQoL. 

Methods. This study assessed the association between educational level (as a proxy for SES), HRQoL (EQ-5D-5L), and health care utilisation (number of appointments with health care providers) by 
performing descriptive statistics and a mediation analysis with a multicategorical independent variable. 

Results. Secondary analysis of a dataset of 433 patients with long-term complaints after Q-fever showed that patients with lower educational level had a lower HRQoL than those with higher 
education. However, the results did not show a difference between educational level on the number of appointments with healthcare providers, nor that healthcare utilisation mediated the association 
between educational level and HRQoL. 

Conclusion. This research increased the knowledge of the long-term consequences of Q-fever and showed the opportunities to assess mechanisms between macro determinants and long-term health 
outcomes for Q-fever patients. It is recommended to assess these underlying patterns and improve care for patients with chronic diseases following zoonoses based on future research.}
}