Socioeconomic Inequality in the Diabetes Care Cascade in Indonesia, 2013–2023: Key Drivers and Gender Differences
1
Global Health Unit, Department of Health Sciences, University Medical Centrum Groningen, Groningen, Netherlands
2
Unit of Pharmaco-Therapy, -Epidemiology, and -Economics (PTEE), University of Groningen, Groningen, Netherlands
3
Center for Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, Indonesia
4
Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
5
Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
6
Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
7
Metabolic, Cardiovascular, and Aging Research Cluster, The Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
8
Division of Pharmacology and Therapy, Department of Anatomy, Histology and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
9
Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
10
Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
Popul. Med. 2026;8(Supplement Supplement 1):A1297
ABSTRACT
INTRODUCTION:
Indonesia’s diabetes burden is rising, and following the expansion of universal health coverage in 2014, assessing equity in the care cascade is paramount.1,2 This study examined time trends and drivers of socioeconomic inequality in diagnosed, treated, and controlled diabetes between 2013 and 2023, comparing patterns by sex.
METHODS:
We conducted repeated cross-sectional analyses of adults with diabetes using secondary biomedical data from the Indonesian National Health Survey (2013, N = 3,971; 2023, N = 2,830). Socioeconomic inequality was assessed using Erreygers’ and Wagstaff's concentration indices, and the contributions of sociodemographic, behavioral, and healthcare inaccessibility factors were analyzed using Wagstaff’s regression-based decomposition.3–5
RESULTS:
All outcomes showed significantly pro-rich inequality in both years for both sexes, though levels declined over time, with men consistently experiencing higher inequality. In 2013, higher education, urban residence, and inaccessibility of healthcare contributed 9%–21%, 19%–24%, and 7%–16% of inequality among women, and 35%–46%, 3%–9%, and 5%–9% among men. By 2023, inequality in diabetes control had become non-significant. Education’s contribution to inequality in diagnosed or treated diabetes doubled among women but remained stable among men. Urban residence contributed more to men than to women, and the contribution of inaccessibility to healthcare was below 5% for both groups. Primary-sector work was a positive contributor to inequality in women (about 12%) and men (25%–35%), whereas formal employment reduced inequality among men by 26%–46%.
CONCLUSIONS:
Equity in diabetes care has modestly improved, particularly for women, yet gaps persist among poorer women and among both poorer and wealthier men due to educational and occupational barriers. These highlight the need for gender-responsive strategies and stronger multisectoral collaboration to improve equitable access to diabetes care.
Indonesia’s diabetes burden is rising, and following the expansion of universal health coverage in 2014, assessing equity in the care cascade is paramount.1,2 This study examined time trends and drivers of socioeconomic inequality in diagnosed, treated, and controlled diabetes between 2013 and 2023, comparing patterns by sex.
METHODS:
We conducted repeated cross-sectional analyses of adults with diabetes using secondary biomedical data from the Indonesian National Health Survey (2013, N = 3,971; 2023, N = 2,830). Socioeconomic inequality was assessed using Erreygers’ and Wagstaff's concentration indices, and the contributions of sociodemographic, behavioral, and healthcare inaccessibility factors were analyzed using Wagstaff’s regression-based decomposition.3–5
RESULTS:
All outcomes showed significantly pro-rich inequality in both years for both sexes, though levels declined over time, with men consistently experiencing higher inequality. In 2013, higher education, urban residence, and inaccessibility of healthcare contributed 9%–21%, 19%–24%, and 7%–16% of inequality among women, and 35%–46%, 3%–9%, and 5%–9% among men. By 2023, inequality in diabetes control had become non-significant. Education’s contribution to inequality in diagnosed or treated diabetes doubled among women but remained stable among men. Urban residence contributed more to men than to women, and the contribution of inaccessibility to healthcare was below 5% for both groups. Primary-sector work was a positive contributor to inequality in women (about 12%) and men (25%–35%), whereas formal employment reduced inequality among men by 26%–46%.
CONCLUSIONS:
Equity in diabetes care has modestly improved, particularly for women, yet gaps persist among poorer women and among both poorer and wealthier men due to educational and occupational barriers. These highlight the need for gender-responsive strategies and stronger multisectoral collaboration to improve equitable access to diabetes care.
| eISSN: | 2654-1459 |
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