PT  - JOURNAL ARTICLE
AU  - Sarah Wamala
AU  - Juan Merlo
AU  - Gunnel Boström
AU  - Christer Hogstedt
TI  - Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden
AID  - 10.1136/jech.2006.049999
DP  - 2007 May 01
TA  - Journal of Epidemiology and Community Health
PG  - 409--415
VI  - 61
IP  - 5
4099  - http://jech.bmj.com/content/61/5/409.short
4100  - http://jech.bmj.com/content/61/5/409.full
SO  - J Epidemiol Community Health2007 May 01; 61
AB  - 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.