Inequalities in health care and behaviour in patients with diabetes and concurrent hypertension in Lahore, Pakistan

The global healthcare delivery system is largely inequitable and patients suffer inequalities in relation to their socioeconomic status (SES). In this study, we applied univariate measures to predict the SES in a sample of patients. We investigated the relationship between patient’s SES, adherence to drug, dietary intake and health behaviour. We also investigated if inequalities exist in physician’s choice on multisource oral solid hypoglycaemic and antihypertensive drugs in a sample of male type II diabetes mellitus patients with concurrent hypertension. Questionnaires were administered on patients (N=500) with diabetes mellitus and concurrent hypertension to determine their SES, prescribed drugs, dietary regime and health behaviour in Lahore, Pakistan. Correlation was determined using chi-square test for category characteristics, Kruskall-Wallis or ANOVA for continuous data variables non-normal or normally distributed data, respectively. The patient’s SES was indicated by univariate like income, occupation, and education. Patients with high SES were more adherent to drug, dietary intake and health behaviour (χ² =13.16, p<0.001; 34.71, p<0.0001; 79.24, p<0.0001, respectively). Patients with lower SES were prescribed cheaper hypoglycaemic and antihypertensive alternatives than their richer counterparts (p<0.0001). Socioeconomic differentials exist within urban communities; these differentials have direct effects on healthcare delivery and patient health.

Keywords
diabetes mellitus; hypertension; socioeconomic; health behaviour; medication intake; Pakistan