Who knows doctors, and who do doctors know? A cross-sectional study of socio-economic inequalities in social networks from the Great British Class Survey

BackgroundPatients with lower socio-economic status persistently report poorer health care access and experiences in the UK, while doctors are disproportionately from higher socio-economic backgrounds. No studies have characterised how socio-economic factors associate with knowing a doctor, and the socio-economic diversity of doctors’ social networks, which may contribute to health care inequalities.MethodsSocial contacts reported by participants of the Great British Class Survey (2011-2013) were analysed to examine (1) how socio-economic factors throughout the life course associated with knowing a doctor socially, among all participants living in the UK (N = 293,912), and (2) the socio-economic diversity of social networks, comparing doctors to other occupational classes, among all UK-based participants aged 23 or above and not retired (N = 230,424). Associations with individual factors were estimated from fixed-effects regression models including adjustment for potential confounders, while associations between outcomes and social strata comprising multiple socio-economic factors in combination were estimated using the intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. ResultsSocial mixing with doctors was very strongly socio-economically stratified (sample average = 59.3%), with estimated likelihood of knowing a doctor from intersectional models varying between 89.1% (approx. 95% CI: [87.9%-90.1%]) for the most advantaged strata (professional/managerial background + fee-paying (private) school + professional/managerial occupation + ≥ £200,000 income), and only 28.3% [26.3%-30.2%] for the least advantaged (working class background + non fee-paying (state) school + working class occupation + < £10,000 income). Strong associations were observed for several individual factors reflecting socio-economic position from childhood to current day.Among working-age participants, those working as doctors (n = 3,805) had the lowest likelihood of having at least one social contact (of 13 listed) in a working class occupation (adjusted mean probability = 66.0%, 95% CI: [64.3%-67.7%]), significantly lower than both comparable high-income occupations and lower socio-economic status occupations. Doctors from professional/managerial private-school backgrounds were least likely to have working class contacts (54.3%), while doctors from working class state-school backgrounds were most likely (78.0%), albeit still below the sample average (81.5%).SummarySocio-economic position across the life course appears to have a cumulative effect, with the most advantaged almost certain to know a doctor socially. Meanwhile, doctors appear socially isolated from patients from lower socio-economic groups, especially doctors with the most privileged backgrounds. How these inequalities in social contacts affect access to care and patient-doctor interactions is currently unknown, and requires future research.