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Low socioeconomic status and absence of supplemental health insurance as barriers to diabetes care access and utilization

Kwan J, Razzaq A, Leiter LA, Lillie D, Hux JE. Can J Diabetes. 2008; 32(3):174-81.


Objective — To identify patient-reported barriers that contribute to the gap between current and optimal diabetes care.

Methods — Random-digit dialling was used to select 763 patients with diabetes representative of the Ontario population and 387 patients with diabetes sampled from low-income neighbourhoods. Data were obtained using a standardized telephone survey.

Results — In multivariate analysis, annual household income <$30 000 was an independent predictor of skipping blood glucose (BG) testing (OR 1.88, 95% CI 1.10-3.19) and not purchasing healthy foods (OR 3.44, 95% CI 2.29-5.15) due to cost. Absence of supplemental insurance was an independent predictor of skipping medications (OR 5.17, 95% CI 3.07-8.72) and BG testing (OR 4.37, 95% CI 2.71-7.05) due to cost, but education level was not.

Conclusions — Low socioeconomic status and the absence of supplemental health insurance act as financial barriers to accessing optimal care. These barriers may be amenable to policy change.

Keywords: Diabetes Equity in health care Social determinants of health

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