Diabetes-related inequalities in health status and financial barriers to health care access in a population-based study
Article first published online: 31 OCT 2003
Volume 21, Issue 1, pages 45–51, January 2004
How to Cite
Gulliford, M. C., Mahabir, D. and Rocke, B. (2004), Diabetes-related inequalities in health status and financial barriers to health care access in a population-based study. Diabetic Medicine, 21: 45–51. doi: 10.1046/j.1464-5491.2003.01061.x
- Issue published online: 28 NOV 2003
- Article first published online: 31 OCT 2003
- Accepted 9 May 2003
- diabetes mellitus;
- health status;
- access to health care;
- private sector;
- health insurance;
Aims We evaluated the relationship between diabetes, health status, household income and expenditure on health care in the general population in Trinidad.
Methods Multistage sampling of 300 households was used to select a sample of 548 adults aged ≥ 25 years. There were 64 (12%) who reported a diagnosis of diabetes. Comparison was made with 128 non-diabetic controls who were frequency matched for age and sex.
Results Subjects with diabetes had lower income levels than non-diabetic controls [income ≤ US$533 per month for 66% diabetes cases and 48% controls, test for trend P = 0.007]. Compared with controls, subjects with diabetes were less likely to have good or very good self-rated health (diabetes 32%, controls 67%; P < 0.001), and more frequently reported long-standing illness, limitation of activities, visual impairment, or self-reported history of high blood pressure, angina or heart attack. Subjects with diabetes (11%) were less likely than controls (30%) to have private health insurance (P = 0.005). Diabetic subjects (35%) were more likely than controls (16%) to have incurred expenditure on doctors’ services in the last 4 weeks (P = 0.021).
Conclusions Diabetes is associated with worse health status and more frequent expenditure on medical services but greater financial barriers to access in terms of low income and lack of health insurance. Policies for diabetes should specifically address the problem of income-related variations in risk of diabetes, health care needs and barriers to uptake of preventive and treatment services, otherwise inequalities in health from this condition may increase.