Diabetes-related Inequalities in Health Status and Financial Barriers to Health Care Access in a Population-Based Study

Diabet Med. 2004 Jan;21(1):45-51. doi: 10.1046/j.1464-5491.2003.01061.x.


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 > or = 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 < or = US dollars 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.

MeSH terms

  • Adult
  • Aged
  • Diabetes Complications
  • Diabetes Mellitus / economics
  • Diabetes Mellitus / epidemiology*
  • Educational Status
  • Female
  • Financing, Personal / economics
  • Health Services Accessibility / economics*
  • Health Status*
  • Humans
  • Income*
  • Insurance, Health
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care
  • Population Surveillance / methods
  • Prevalence
  • Self-Assessment
  • Trinidad and Tobago / epidemiology