Advertisement

International Journal of Public Health

, Volume 61, Issue 5, pp 613–620 | Cite as

Decomposing socioeconomic inequalities in the use of preventive eye screening services among individuals with diabetes in Korea

  • Jongnam HwangEmail author
Original Article

Abstract

Objectives

The aim of this study was to assess the socioeconomic inequalities in the use of preventive eye screening services among individuals with diabetes in Korea.

Methods

Using nationally representative survey data, the concentration index (CI) and decomposition of the CI were used to capture and quantify income-related inequalities.

Results

The results show income-related inequality in the use of eye screening services among individuals with diabetes, suggesting that services were concentrated among individuals with higher incomes. After adjusting for need factors, such as sex, age and self-rated health, the inequality still persisted as observed horizontal inequity in the services, indicating that unequal care was provided for equal need. The decomposition approach revealed that the largest contributions to the observed inequality were higher education and higher income levels. Having private insurance and residing in non-Seoul metro areas also contributed to the observed pro-rich inequality.

Conclusions

These findings suggest that income- and education-related barriers to the use of preventive eye screening services for individuals with diabetes should be targeted for removal at the national level to achieve the goal of equal care for equal need in diabetes management.

Keywords

Concentration index Decomposition Diabetes Preventive eye care services Inequality Socioeconomic status 

Notes

Acknowledgments

The author is grateful to Dr. Patricia O’Campo and ACHIEVE (Action for Health Equity Interventions) Post-Doctoral Fellows at St. Michael’s Hospital, Canada, for their critical comments on an earlier version of this paper.

References

  1. Allin S (2008) Does equity in healthcare use vary across Canadian provinces? Healthc Policy 3(4):83–99PubMedPubMedCentralGoogle Scholar
  2. Asada Y (2005) A framework for measuring health inequity. J Epidemiol Community Health 59(8):700–705. doi: 10.1136/jech.2004.031054 CrossRefPubMedPubMedCentralGoogle Scholar
  3. Asada Y, Kephart G (2007) Equity in health services use and intensity of use in Canada. BMC Health Serv Res 7(1):41CrossRefPubMedPubMedCentralGoogle Scholar
  4. Borrell C, Fernandez E, Schiaffino A, Benach J, Rajmil L, Villalbi Segura A (2001) Social class inequalities in the use of and access to health services in Catalonia, Spain: what is the influence of supplemental private health insurance? Int J Qual Health C 13(2):117–125. doi: 10.1093/intqhc/13.2.117 CrossRefGoogle Scholar
  5. Boyd S, Advani A, Altomare F, Stockl F (2013) Canadian Diabetes Association 2013 Clinical practice guidelines for the prevention and management of diabetes in Canada: retinopathy. Can J Diabetes 37(suppl1):S137–S141CrossRefPubMedGoogle Scholar
  6. Brown AF, Ettner SK, Piette J, Weinberger M, Gregg E, Shapiro MF, Karter AJ, Safford M, Waitzfelder B, Prata PA, Beckles GL (2004) Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiol Rev 26(1):63–77. doi: 10.1093/epirev/mxh002 CrossRefPubMedGoogle Scholar
  7. Buhrmann R, Houdege W, Beardmore J, Baker G, Lowcock B, Pan I, Bovell A (2007) Section 2. The epidemiology of blindness and visual impairment in Canada: diabetic retinopathy. In: Foundations for a Canadian Vision Health Strategy: towards preventing avoidable blindness and promoting vision health. The National Coalition for Vision Health, pp 12–26Google Scholar
  8. Byun S, Ma S, Jun J, Jung K, Park B (2013) Screening for diabetic retinopathy and nephropathy in patients with diabetes: a nationwide survey in Korea. PLoS One 8(5):e62991. doi: 10.1371/journal.pone.0062991 CrossRefPubMedPubMedCentralGoogle Scholar
  9. Carrieri V, Wuebker A (2013) Assessing inequalities in preventive care use in Europe. Health Policy 113(3):247–257. doi: 10.1016/j.healthpol.2013.09.014 CrossRefPubMedGoogle Scholar
  10. Chaturvedi N, Stephenson J, Fuller J, Complications TEI (1996) The relationship between socioeconomic status and diabetes control and complications in the EURODIAB IDDM complications study. Diabetes Care 19(5):423–430. doi: 10.2337/diacare.19.5.423 CrossRefPubMedGoogle Scholar
  11. Cho H (2013) Equity in health care: current situation in South Korea. J Korean Med Assoc 56(3):184–194CrossRefGoogle Scholar
  12. Dunlop S, Coyte PC, McIsaac W (2000) Socio-economic status and the utilisation of physicians’ services: results from the Canadian National Population Health Survey. Soc Sci Med 51(1):123–133. doi: 10.1016/S0277-9536(99)00424-4 CrossRefPubMedGoogle Scholar
  13. Fraser S, Edwards L (2010) Health equity audit—diabetic retinopathy screening: Southampton City, Hampshire, Isle of Wight and Portsmouth City PCTs. Southampton City PCTGoogle Scholar
  14. Frohlich KL, Ross N, Richmond C (2006) Health disparities in Canada today: some evidence and a theoretical framework. Health Policy 79(2–3):132–143. doi: 10.1016/j.healthpol.2005.12.010 CrossRefPubMedGoogle Scholar
  15. Gallo LC, Matthews KA (2003) Understanding the association between socioeconomic status and physical health: do negative emotions play a role? Psychol Bull 129(1):10–51. doi: 10.1037/0033-2909.129.1.10 CrossRefPubMedGoogle Scholar
  16. Health Insurance Review and Assessement Service (2015) Healthcare resource statistics. Korea Health Insurance Review and Assessment Service Web. http://www.hira.or.kr/re/gisresource/GisInfo.do?pgmid=HIRAA030501000000. Accessed 22 Feb 2015
  17. Heo J, Oh J, Kim J, Lee M, Lee JS, Kwon S, Subramanian SV, Kawachi I (2012) Poverty in the midst of plenty: unmet needs and distribution of health care resources in South Korea. PLoS One 7(11):e51004. doi: 10.1371/journal.pone.0051004 CrossRefPubMedPubMedCentralGoogle Scholar
  18. Hooper P, Boucher MC, Cruess A, Dawson KG, Delpero W, Greve M, Kozousek V, Lam WC, Maberley DAL (2012) Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy. Can J Ophthalmol 47(2 Suppl):S1–S30. doi: 10.1016/j.jcjo.2011.12.025 CrossRefPubMedGoogle Scholar
  19. Hwang J, Johnson JA (2015) Relationship between duration of type 2 diabetes and self-reported participation in diabetes education in Korea. Asia-Pac J Public Health 27(2):NP311-21. doi: 10.1177/1010539512440592
  20. Hwang J, Shon C (2014) Relationship between socioeconomic status and type 2 diabetes: results from Korea National Health and Nutrition Examination Survey (KNHANES) 2010–2012. BMJ Open 4(8):e005710. doi: 10.1136/bmjopen-2014-005710 CrossRefPubMedPubMedCentralGoogle Scholar
  21. Hwang J, Rudnisky C, Bowen S, Johnson JA (2015) Socioeconomic factors associated with visual impairment and ophthalmic care utilization in patients with type II diabetes. Can J Ophthalmol 50(2):119–126. doi: 10.1016/j.jcjo.2014.11.014 CrossRefPubMedGoogle Scholar
  22. Jotkowitz AB, Rabinowitz G, Segal AR, Weitzman R, Epstein L, Porath A (2006) Do patients with diabetes and low socioeconomic status receive less care and have worse outcomes? A national Study. Am J Med 119(8):665–669. doi: 10.1016/j.amjmed.2006.02.010 CrossRefPubMedGoogle Scholar
  23. KAMS (2014) Evidence-based recommendations for type 2diabetes in primary care. Korean Academy of Medical Sciences, SeoulGoogle Scholar
  24. Klein R, Klein BK, Moss SE, Davis MD, DeMets DL (1984) The wisconsin epidemiologic study of diabetic retinopathy: III. prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 102(4):527–532. doi: 10.1001/archopht.1984.01040030405011 CrossRefPubMedGoogle Scholar
  25. Kliner M, Fell G, Gibbons C, Dhothar M, Mookhtiar M, Cassels-Brown A (2012) Diabetic retinopathy equity profile in a multi-ethnic, deprived population in Northern England. Eye 26(5):671–677. doi: 10.1038/eye.2012.3 CrossRefPubMedPubMedCentralGoogle Scholar
  26. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, Chun C, Kang YH, Oh K (2014) Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol 43(1):69–77. doi: 10.1093/ije/dyt228 CrossRefPubMedPubMedCentralGoogle Scholar
  27. Kwon S (2009) Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage. Health Policy Plan 24(1):63–71. doi: 10.1093/heapol/czn037 CrossRefPubMedGoogle Scholar
  28. Lorant V, Boland B, Humblet P, Deliège D (2002) Equity in prevention and health care. J Epidemiol Community Health 56(7):510–516. doi: 10.1136/jech.56.7.510 CrossRefPubMedPubMedCentralGoogle Scholar
  29. Lu JF, Leung G, Kwon S, Tin K, Van Doorslaer E, O’Donnell O (2007) Horizontal equity in health care utilization evidence from three high-income Asian economies. Soc Sci Med 64(1):199–212. doi: 10.1016/j.socscimed.2006.08.033 CrossRefPubMedGoogle Scholar
  30. Matthews KA, Gallo LC (2011) Psychological perspectives on pathways linking socioeconomic status and physical health. Annu Rev Psychol 62:501–530. doi: 10.1146/annurev.psych.031809.130711 CrossRefPubMedPubMedCentralGoogle Scholar
  31. McCarty CA, Lloyd-Smith CW, Lee SE, Livingston PM, Stanislavsky YL, Taylor HR (1998) Use of eye care services by people with diabetes: the Melbourne Visual Impairment Project. Br J Ophthalmol 82(4):410–414. doi: 10.1136/bjo.82.4.410 CrossRefPubMedPubMedCentralGoogle Scholar
  32. McGrail KM (2008) Income-related inequities: cross-sectional analyses of the use of medicare services in British Columbia in 1992 and 2002. Open Med 2(4):e91PubMedPubMedCentralGoogle Scholar
  33. Millett C, Dodhia H (2006) Diabetes retinopathy screening: audit of equity in participation and selected outcomes in South East London. J Med Screen 13(3):152–155. doi: 10.1258/096914106778440608 CrossRefPubMedGoogle Scholar
  34. Morris S, Sutton M, Gravelle H (2005) Inequity and inequality in the use of health care in England: an empirical investigation. Soc Sci Med 60(6):1251–1266. doi: 10.1016/j.socscimed.2004.07.016 CrossRefPubMedGoogle Scholar
  35. Moss S, Klein R, Klein B (1995) Factors associated with having eye examinations in persons with diabetes. Arch Fam Med 4(6):529–534CrossRefPubMedGoogle Scholar
  36. O’Donnell O, van Doorslear E, Wagstaff A, Lindelow M (2008) Analyzing health equity using household survey data: a guide to techniques and their impementation. World Bank, Washington, DCGoogle Scholar
  37. OECD (2013) Diabetes prevalence and incidence. In: Health at a glance 2013: OECD indicator. Organisation for Economic Co-operation Development Publishing, ParisGoogle Scholar
  38. Perruccio AV, Badley EM, Trope GE (2010) A Canadian population-based study of vision problems: assessing the significance of socioeconomic status. Can J Ophthalmol 45(5):477–483. doi: 10.3129/i10-061 CrossRefPubMedGoogle Scholar
  39. Saadine J, Fong D, Yao J (2008) Factors associated with follow-up eye examinations among persons with diabetes. Retina 28(2):195–200 (1) CrossRefPubMedGoogle Scholar
  40. Scanlon PH, Carter SC, Foy C, Husband RF, Abbas J, Bachmann MO (2008) Diabetic retinopathy and socioeconomic deprivation in Gloucestershire. J Med Screen 15(3):118–121. doi: 10.1258/jms.2008.008013 CrossRefPubMedGoogle Scholar
  41. Vandenheede H, Deboosere P, Espelt A, Bopp M, Borrell C, Costa G, Eikem TA, Gnavi R, Hoffmann R et al (2015) Educational inequalities in diabetes mortality across Europe in the 2000s: the interaction with gender. Int J Public Health 60(4):401–410. doi: 10.1007/s00038-015-0669-8 CrossRefPubMedPubMedCentralGoogle Scholar
  42. Veugelers P, Yip A (2003) Socioeconomic disparities in health care use: does universal coverage reduce inequalities in health? J Epidemiol Community Health 57(6):424–428. doi: 10.1136/jech.57.6.424 CrossRefPubMedPubMedCentralGoogle Scholar
  43. WHO (2008) Commission on social determinants of health final report backgrounder- key concepts. World Health Organisation Web. http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/. Accessed 1 Feb 2016

Copyright information

© Swiss School of Public Health (SSPH+) 2016

Authors and Affiliations

  1. 1.Department of Health PromotionDaegu UniversityGyeongsan-SiRepublic of Korea

Personalised recommendations