In Iran, the rising burden of diabetes and recent health system reforms underscore the need to assess inequalities across the diabetes care cascade. We evaluated socioeconomic inequalities in diabetes prevalence and care cascade in Iran. This study utilized data from the 2016 and 2021 Iran STEPS surveys. Diabetes prevalence and care cascade (including awareness, treatment, and glycemic control) were defined using laboratory and self-reported data. Socioeconomic inequalities were estimated using the regression-based slope index of inequality (SII) and the relative index of inequality (RII) across two dimensions of wealth and education. All analyses incorporated survey weights. A total number of 37,207 adults (19,113 in 2016 and 18,094 in 2021) were included in this study. In both years, significant wealth-related inequalities were observed in the age- and sex-adjusted diabetes prevalence (RII: 0.65 0.54–0.78 in 2016 and RII: 0.68 0.55–0.84 in 2021) and awareness (RII: 0.88 0.79–0.98 in 2016 and a borderline RII: 0.88 0.78–1.00 in 2021). In contrast to 2016, a significant disparity in diabetes treatment was observed across wealth quintiles in 2021 (RII: 0.82 0.71–0.96). Regarding disparities across educational levels, the adjusted model revealed a significant inequality in achieving fair glycemic control in 2021 (RII: 0.77 0.62–0.96). Wealth-related disparities in diabetes prevalence and awareness persisted, with prevalence and awareness disproportionately higher among the wealthier. New disparities emerged in 2021: the poor faced lower rates of diabetes treatment, while less-educated individuals exhibited poorer glycemic control.
Younesian et al. (Tue,) studied this question.