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Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden
  1. Sarah Wamala1,
  2. Juan Merlo2,
  3. Gunnel Boström3,
  4. Christer Hogstedt3
  1. 1Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Clinical Sciences in Malmö, Public Health and Community Medicine, Lund University, Malmö, Sweden
  3. 3National Institute of Public Health, Stockholm, Sweden
  1. Correspondence to:
 Dr S Wamala
 National Institute of Public Health, Box 3358, 103 67 Stockholm, Sweden; sarah.wamala{at}


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.

  • SDI, Socioeconomic Disadvantage Index
  • SI, Synergy Index

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  • Competing interests: None.

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