Socioeconomic inequalities in utilization of preventive health services in relation to cardiovascular disease and diabetes
Jianzhen Zhang, Brian F. Oldenburg
Background: Substantial evidence suggests an inverse relation between all-cause mortality and indicators of socioeconomic position (SEP). However, while lower SEP groups are more likely to use medical services due to their increased morbidity, research suggests they are less likely to use preventive health services. National and international research indicates that despite the increasing use of different types of preventive health services, significant SEP-related disparities remain. This study examines the relationship between SEP and the utilization of preventive health services provided by general practitioners (GPs) for cardiovascular disease (CVD) and diabetes in Australia. Methods: A self-administered mailed questionnaire survey from 518 participants aged 25-64 years was conducted in Brisbane, Australia, in November 2004. SEP was measured by education and family income levels. Using multivariable analysis, rates of preventive checkups for blood pressure, blood cholesterol (BC) and blood glucose (BG), and for the presence of CVD and/or diabetes were compared by SEP group. Results: People from a lower educational background (P < 0.05, 95% confidence interval [CI]: 1.11-3.39) and lower income families (P < 0.05, 95% CI: 1.26-4.24) were twice as likely to report having CVD and/or diabetes. However, lower income respondents were 2.6 times less likely to have had their BC checked (P < 0.05, 95% CI: 0.16-0.89) and those with lower education were half as likely to have had their BC checked (P < 0.05, 95% CI: 0.26-0.94). Respondents with a lower education were nearly half as likely to have had their BG checked (P < 0.05, 95% CI: 0.28-0.97). Conclusions: Some important SEP differences were identified in self-reported utilization of GP preventive health services in relation to CVD and diabetes. Regular checkups for lower SEP groups should be incorporated into GP consultations in primary health care settings.