EVIDENCE BASED PUBLIC HEALTH POLICY AND PRACTICE

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

Sarah Wamala¹, Juan Merlo², Gunnel Boström³, Christer Hogstedt³

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

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