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


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.



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

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