Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden.
OBJECTIVE
To analyse the association between perceived discrimination and refraining from seeking required medical treatment and the contribution of socioeconomic disadvantage.


METHODS
Data from the Swedish National Survey of Public Health 2004 were used for analysis. Respondents were asked whether they had refrained from seeking required medical treatment during the past 3 months. Perceived discrimination was based on whether respondents reported that they had been treated in a way that made them feel humiliated (due to ethnicity/race, religion, gender, sexual orientation, age or disability). The Socioeconomic Disadvantage Index (SDI) was developed to measure economic deprivation (social welfare beneficiary, being unemployed, financial crisis and lack of cash reserves).


METHODS
Swedish population-based survey of 14,736 men and 17,115 women.


RESULTS
Both perceived discrimination and socioeconomic disadvantage were independently associated with refraining from seeking medical treatment. Experiences of frequent discrimination even without any socioeconomic disadvantage were associated with three to nine-fold increased odds for refraining from seeking medical treatment. A combination of both frequent discrimination and severe SDI was associated with a multiplicative effect on refraining from seeking medical treatment, but this effect was statistically more conclusive among women (OR = 11.6, 95% CI 8.1 to 16.6; Synergy Index (SI) = 2.0 (95% CI 1.2 to 3.2)) than among men (OR = 12, 95% CI 7.7 to 18.7; SI = 1.6 (95% CI 1.3 to 2.1)).


CONCLUSIONS
The goal of equitable access to healthcare services cannot be achieved without public health strategies that confront and tackle discrimination in society and specifically in the healthcare setting.
Wamala
Sarah
S
Karolinska Institutet, Stockholm, Sweden. sarah.wamala@fhi.se
Merlo
Juan
J
Boström
Gunnel
G
Hogstedt
Christer
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011203:Poverty; D011287:Prejudice; D012044:Regression Analysis; D013548:Sweden; D016312:Treatment Refusal / Q000523:psychology*