Poorer diabetics receive worse care than other in countries with universal health coverage

January 26, 2010

People with lower socioeconomic status and those belonging to ethnic minority groups receive worse health care in the treatment of diabetes than the rest of patients in the world's most developed countries. This conclusion emerges from a research conducted at the University of Granada which has accomplished the most comprehensive bibliographic review worldwide to date on health care of this disease in the Organization for Economic Co-operation and Development (OECD) countries that have universal coverage health systems. The OECD brings together the most advanced and developed countries on the planet, and its members account for 70% of the global market.

This work has been carried out by Ignacio Ricci Cabello, from the Department of Nutrition and Food Science at the University of Granada, and directed by professors Isabel Ruiz Pérez (Andalusian School of Public Health) and Soledad Márquez Calderón (Andalusian Regional Ministry of Health). Its main objective was to determine whether health systems provide equitable healthcare to all diabetics, regardless of gender, race, socioeconomic status or country of origin or they do not. In addition, researchers focused on "rich" countries with universal coverage health systems, as these are the best placed to prevent such discrimination.

Late diagnosis

The study results showed that inequalities do exist: people with lower socioeconomic status (low income levels, illiterate, unemployed ...) are diagnosed later. In many cases, before receiving a diagnosis, they suffer complications from the disease that an early diagnosis would avoid.

Moreover, Ignacio Ricci explains, "these groups control their blood sugar levels worse because they do not know how to do it or do not realize the important role played by self-managing their disease in the prevention of diabetes complications.

The UGR researcher points out that "the worst part is carried by minority ethnic groups, who are not only diagnosed later and control their disease worse, but they are also treated differently and have greater difficulty in accessing health services responsible for monitoring the disease (endocrinology, early detection of diabetic retinopathy or diabetic foot programs...) ".

In order to accomplish this work, data were collected from published studies because the methodology used was the systematic review of medic literature. Such researches provide higher level of evidence according to the scientific community, as they review all previously published studies on a particular theme by bringing together all the accumulated scientific knowledge so they can respond to a specific research question. Furthermore, the quality of these studies is assessed as to determine objectively which studies should be taken into account and those which should not.

Ethnic Inequalities

The UGR researcher points out that over 80% of the papers published on ethnic inequalities so far, show that ethnic minority populations access health services related to controlling their disease with greater difficulty, and 85% of the articles on socioeconomic inequalities agree that people with lower socioeconomic level control their disease worse than the rest of patients.

Furthermore, if these inequalities exist in the treatment of diabetes, it would not be surprising to think that they also may exist in the case of other chronic diseases like AIDS, cardiovascular or mental health related diseases. Ultimately, according to the author of this research, "given that social inequalities in health care are unnecessary, unjust and avoidable, results of this study should be taken into account by politicians and health managers to implement social sanitary policies aimed at reducing and eventually eliminating these disparities."

Ignacio Cabello Ricci notes that these results could be somehow "the tip of the iceberg of social inequalities in world health" because, if it is already worrying the existence of inequalities in economically more developed countries that enjoy universal health coverage, "the situation of other countries must be much worse."
-end-
Reference: Ignacio Ricci Cabello, Department of Nutrition and Food Science, University of Granada. Tel: (+34) 958 027 496 E-mail: ignacio.ricci.easp@juntadeandalucia.es

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University of Granada

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