HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wamala, S. Articles by Hogstedt, C. Search for Related Content PubMed PubMed Citation Articles by Wamala, S. Articles by Hogstedt, C. Topic Collections Relevant Article

Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden

¹ Karolinska Institutet, Stockholm, Sweden
² Department of Clinical Sciences in Malmö, Public Health and Community Medicine, Lund University, Malmö, Sweden
³ National Institute of Public Health, Stockholm, Sweden

Correspondence to:
Correspondence to:
Dr S Wamala
National Institute of Public Health, Box 3358, 103 67 Stockholm, Sweden; sarah.wamala{at}fhi.se

Study objective: To analyse the association between perceived discrimination and refraining from seeking required medical treatment and the contribution of socioeconomic disadvantage.

Design and setting: 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).

Participants: Swedish population-based survey of 14 736 men and 17 115 women.

Main 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.

Abbreviations: SDI, Socioeconomic Disadvantage Index; SI, Synergy Index

Relevant Article

In this issue

Carlos Alvarez-Dardet and John R Ashton
J. Epidemiol. Community Health 2007 61: 369. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				S. Wamala, J. Merlo, G. Bostrom, C. Hogstedt, and G. Agren Socioeconomic disadvantage and primary non-adherence with medication in Sweden Int. J. Qual. Health Care, June 1, 2007; 19(3): 134 - 140. [Abstract] [Full Text] [PDF]