Sex and income inequalities in preventive services in diabetes

Eur J Gen Pract. 2023 Dec;29(1):2159941. doi: 10.1080/13814788.2022.2159941.

Abstract

Background: Cancer preventive services (gynaecological cancer screening, colon cancer screening) and cardiometabolic screening are recommended by guidelines to individuals. People with diabetes were less likely to receive them than those without diabetes in some studies.

Objectives: To analyse differences in the coverage of preventive services in people with diabetes compared to non-diabetic individuals and in people with diabetes according to sex and household income.

Methods: We analysed data collected from the European Health Interview Survey 2013-2015, including individuals aged 40-74 (n = 179,318), 15,172 with diabetes from 29 countries. The income of a household (HHI) was described in quintiles. The relationship between the coverage of preventive services (cardiometabolic, vaccination, cancer screening) and sociodemographic characteristics was analysed with multiple logistic regression.

Results: Women comprised 53.8% of the total and 40% were 60-74 years. People with diabetes compared to those without diabetes had higher reported coverage of cardiometabolic screening (98.4% vs. 90.0% in cholesterol measurement; 97.0% vs. 93.6% in blood pressure measurement), colorectal cancer screening (27.1% vs. 24.6%) but lower coverage of gynaecological cancer screening (mammography: 29.2% vs. 33.5%, pap smear test: 28.3% vs. 37.9%). Among diabetic patients, women were less likely to receive cholesterol screening (OR = 0.81; 95% CI: 0.72-0.91) and colon cancer screening (OR = 0.79; 95% CI: 0.73-0.86) compared to men. Being affluent was positively associated with receiving cardiometabolic screening and mammography in diabetic patients.

Conclusion: People with diabetes reported higher coverage of preventive services except gynaecological cancer screening. Disparities were found in diabetes among women and less affluent individuals.

Keywords: Diabetes mellitus; general practice/family medicine; health policy; prevention; surveys.

MeSH terms

  • Cardiovascular Diseases*
  • Cholesterol
  • Colonic Neoplasms*
  • Diabetes Mellitus* / epidemiology
  • Female
  • Health Surveys
  • Humans
  • Income
  • Male
  • Mass Screening

Substances

  • Cholesterol

Grants and funding

This work was supported by the Spanish Society of Family and Community Medicine -semFYC under Grant for completing doctoral theses Isabel Fernández 2018. Foundation for Biomedical Research and Innovation in Primary Care (FIIBAP) under Grant for professional editing services in its 2021 call. This publication has been supported HEALTHSTAR13 project, cofunded by the healthstart Plus programme of Comunidad de Madrid and EU (REACT-EU programme of European Regional Development Fund).