This study aimed to analyze the socio-economic inequality in controlled T2DM variables in Iran.Our results suggest that the controlled triple target and controlled HbA1c variables are positively correlated with individuals with higher SES, consistent with the results of previous studies [8, 15, 18,19,20,21]. This result indicates that people with lower SES are less likely to seek treatment for diabetes. One reason for this may be barriers to accessing health services, such as medical costs, transportation costs, and lack of access to adequate food. [2, 8, 19,20,21]. Additionally, lower SES is associated with lower levels of physical activity and unhealthy behaviors such as smoking. [21, 22]these are risk factors that contribute to the increased prevalence of diabetes.
We found no significant differences in the concentrations of the controlled T2DM variables between gender groups. This suggests that people with lower SES may receive treatment for diabetes less frequently.The prevalence of T2DM in high SES women is low, which is consistent with the results of previous studies [12, 23, 24]. However, contrasting results from other studies indicate a higher prevalence of diabetes in women. [11, 12, 15, 18]. One possible explanation for this trend is that men and women have different perceptions of health, health behaviors, and lifestyles. [23]. Men with the lowest SES often resort to harmful lifestyle behaviors such as smoking, drinking, inactivity, and poor diet as a means of coping with adverse and stressful situations. [12].
Another finding is that there are no significant differences in the concentrations of controlled T2DM variables in different age groups. Overall, the prevalence of T2DM was low among individuals of different age groups belonging to the highest SES. This may be due to the highest levels of SES having easier access to health care, healthy food, sports facilities, education, employment opportunities, and lifestyle choices. [8].
Additionally, HbA1c and FBG variables were found to be better controlled among rural residents with lower SES, indicating a greater focus on diabetes care in this demographic. The dietary differences observed between urban and rural areas, combined with factors such as lack of physical activity, consumption of processed foods, and increased urbanization, may contribute to the increased prevalence of T2DM in urban residents. There may be. [1, 19, 25]. Furthermore, successful control of T2DM has been observed in rural areas due to effective implementation of primary health care (PHC) and management of non-communicable diseases. [11].
Another finding indicates that managed FBG is more concentrated among low SES individuals in areas of low prevalence. This may be due to reduced demand in areas with lower prevalence, which may lead to increased access to health services for individuals with lower SES. Therefore, individuals with lower SES may find it easier to take advantage of the available health services provided by medical centers.
The apparent gradient in diabetes control across socio-economic quintiles was particularly noted with significant findings for triple target, FBG and HbA1c levels, highlighting important insights. That is, socio-economic status plays an important role in diabetes management.
The persistence of this gradient across multiple models, even after adjusting for age, gender, and education, highlights the complex interplay between socioeconomic factors and health, with barriers to diabetes management influencing individual health behaviors. It suggests that it goes beyond and encompasses a broader range of social and economic factors.
The significantly higher probability that the richest quintile achieves the triple goal in the crude model is due to the wide range of benefits afforded by higher SES, including better access to care and resources necessary for effective diabetes management. reflects its advantages.
The consistent importance of the top quintiles, especially the fourth quintile, in improving FBG control across all models highlights the need for targeted medical strategies to address SES disparities. This finding is important for health care providers and policy makers, as it suggests that interventions focused on middle-to-low SES groups may result in significant improvements in diabetes outcomes.
Furthermore, the stronger association between higher SES and better HbA1c control was particularly pronounced in higher quintiles in all models, highlighting the influence of socio-economic factors on glycemic control. . This relationship suggests that effective diabetes management requires going beyond medical treatment and addressing social determinants of health.
These findings collectively highlight the need for comprehensive strategies that take into account socio-economic disparities in diabetes care. Health policy must focus on reducing these gaps through targeted interventions, such as improving diabetes education and access to health services for lower SES groups and supporting programs that address broader determinants of health. It doesn’t have to be. Addressing these disparities is critical to achieving more equitable health outcomes and highlights the importance of integrating social and economic supports into diabetes treatment strategies.
Despite the important findings, this study has certain limitations that should be acknowledged. Psychological factors and variables such as occupation, family structure, smoking, BMI, and other factors were not considered and may contribute to inequalities related to SES and influence study results. Additionally, information about individuals’ income was not accessible, leading to classification based solely on assets. Combining income and assets could have resulted in a more accurate and accurate classification.
To our knowledge, this is the first study to investigate the relationship between socio-economic inequality and T2DM in the Iranian population. The strength of this study lies in the appropriate sample size.
