Socioeconomic Inequalities in Healthcare Access Among Patients With Type 2 Diabetes in Iran: A Cross-Sectional Study Publisher Pubmed



Nikkhah A ; Darvishi A ; Aghakhani A ; Nasli Esfahani E ; Zargar Balajam N ; Heshmat R ; Shafiee G
Source: BMJ Open Published:2026

Abstract

Objective Socioeconomic inequalities significantly impact access to healthcare services for individuals with type 2 diabetes mellitus (T2DM). This study investigates these inequalities in Iran, focusing on factors such as asset, sex, urban–rural residence, age, education, employment status, and marital status. Design Cross-sectional study. Setting This study used data from the national ‘Diabetes Care (DiaCare)’ study, a population-based survey conducted from 2018 to 2020 in Iran. Methods Socioeconomic status (SES) was assessed using Principal Component Analysis (PCA) based on assets. Socioeconomic inequalities in access to physicians, pharmacies and laboratories were measured using the Concentration Index (CI) and Erreygers Corrected Concentration Index (ECI). Decomposition analysis was performed using a probit regression model to assess the contributions of various factors to the observed inequalities. Results Among 13 315 patients with T2DM, 5.8% lacked access to physicians, 6.8% to pharmacies and 8.7% to laboratories. The CI was positive and statistically significant for access to physicians (0.0614), pharmacies (0.0787) and laboratories (0.0875), indicating better access concentrated among higher SES individuals. Urban residents had the largest positive marginal effects on access to physicians (0.032), pharmacies (0.078) and laboratories (0.053), with percentage contributions of 13.21%, 23.23% and 17.39%, respectively. Higher asset quintiles showed substantial contributions to inequalities, with the highest quintile contributing 10.5% to physician access inequality, 9.68% to pharmacy access and 9.16% to laboratory access. Education level also positively impacted access, with high school education contributing 0.64% and college education 0.52% to access inequalities. Sex differences showed a negative marginal effect for women, indicating slightly lower access. Conclusion Socioeconomic factors, particularly asset, residence and education, significantly impact access to healthcare services for patients with T2DM in Iran. Policies should focus on reducing barriers to healthcare access, especially for lower SES and rural populations. © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.