Objective To assess the independent impact of wealth status (as determined by a validated index) on health outcomes in Pakistan.

Methods Secondary data analysis of the Pakistan Demographic Health Survey (PDHS) database 2006–2007 was performed. The Maternal database consisted of 10 023 women aged 15–49 years, births database 39 049 children, while children's database consisted of 9177 children. Multivariate logistic regression analysis was performed using STATA V 9.0 and SPSS 10.0.

Findings The adjusted OR and 95% CI for having delivery attended by a skilled healthcare provider with reference to the poorest quintile were poorer 1.44 (1.19 to 1.75), middle 1.86 (1.52 to 2.28), richer 3.02 (2.43 to 3.76) and richest 5.40 (4.16 to 7.01), p<0.0001. The adjusted OR and 95% CI of mortality among children under 5 years age in Pakistan with reference to the poorest quintile were poorer 0.89 (0.81 to 0.97), middle 0.72 (0.65 to 0.81), richer 0.69 (0.62 to 0.78) and richest 0.65 (0.55 to 0.76), p<0.0001. Other indicators of child health; Neonatal mortality, Infant mortality, Vaccination status and reproductive health indicator such as emergency obstetric care availability were statistically significantly associated with wealth index quintiles, adjusting for confounding factors.

Conclusion These representative data from Pakistan quantify the burden of morbidity and mortality associated with unjust distribution of wealth in the country. There are wide disparities in access to health in different socioeconomic groups as evidenced by this study. Social protection for health is needed so that those in the informal sector are not excluded from accessing healthcare. In addition scale- up of poverty reduction strategies and promotion of inter-sectoral action is needed.