Even in Sweden, a country with universal healthcare, disadvantaged people with diabetes are still more likely to die compared to diabetics with social and economic advantages, a new study finds.
The risk of death was affected by marital status, education, immigration history and wealth, even though these factors don't stand in the way of receiving healthcare for the people in the study.
"Sweden is arguably one of the most equitable countries in the world when it comes to use and access to healthcare," said lead author Dr. Araz Rawshani, of Sahlgrenska University Hospital in Gothenburg.
He told Reuters Health that after accounting for health risks like blood pressure and cholesterol, his team hadn't expected to see differences in death rates.
But social and economic risk factors did remain strong predictors of death, the study found.
The researchers used data collected from 2003 through 2012 on more than 217,000 adults. The average age when they enrolled in the registry was 58. The median follow-up was 5.6 years.
During the study, there were 19,105 deaths. About 60 percent were related to heart disease, about 37 percent were tied to diabetes and about 34 percent were linked to cancer.
Compared to unmarried people, married individuals were about 27 percent less likely to die from any cause. Their deaths were also less likely to be related to heart disease and diabetes.
Similarly, compared to people in the top quintile for income, those in the lowest quintile were 71 percent more likely to die from any cause, and their deaths were more likely to be related to heart disease, diabetes and cancer.
Immigrants from non-Western countries were less likely to die during the study than native Swedes. Also, people with college degrees had lower death rates than their less educated peers.
Overall, after adjustments, low social and economic status was tied to a two-fold increased risk of death from any cause, heart disease and diabetes, the researchers reported June 27 in JAMA Internal Medicine.
There was also a small increased risk of death from cancer tied to those factors.
Rawshani said heart disease is the leading cause of death in the U.S. and worldwide, and the results show social and economic factors play a role regardless of medical risk factors like blood pressure and cholesterol levels.
"Perhaps the healthcare system should treat low-socioeconomic patients more aggressively," he said.
Disadvantaged people may have psychological stress, unemployment, unhealthy habits and other problems tied to poor health, his team notes.
The researchers admit that their study can't prove low social and economic status caused people to die sooner than their more advantaged peers. Also, they lacked information about certain lifestyle factors, such as drinking and smoking habits.