Disadvantage linked to major risk of chronic disease

Australian research linking low socioeconomic status to a higher risk of developing nine out of 10 common chronic diseases highlights the challenge facing many GPs working in areas of disadvantage.
 
Published in the Medical Journal of Australia, the study measured socioeconomic factors alongside the rate of 10 chronic conditions in more than 11 million Australians aged 40 and older.
 
Conditions included were arthritis, asthma, cancer, dementia, diabetes, heart disease, kidney disease, lung disease, mental health conditions, and stroke.
 
Researchers found socioeconomic position to be a major risk factor for chronic disease, with the prevalence of nine of 10 diseases increasing with socioeconomic disadvantage.
 
The exception was cancer, where rates decreased alongside increasing socioeconomic disadvantage in most sex-specific age groups.
 
‘We found that the prevalence of chronic disease differed markedly by socioeconomic position; in contrast, the influence of education level and occupational grade was less consistent,’ the authors wrote.
 
Study co-author Dr Joanna Gong from the Baker Heart and Diabetes Institute said coordinated efforts are needed to reduce the health impacts of social disadvantage, and primary care has an important role in supporting progress.
 
‘GPs are often the first to see how socioeconomic position affects health and are well placed to respond in meaningful ways,’ she told newsGP.
 
‘While it can be challenging given time and resource constraints, identifying social stressors, adapting care, and linking patients in with local services can help prevent illness from worsening and reduce long-term health inequities.’
 
Chair of RACGP Specific Interests Poverty and Health, Dr Tim Senior, said the findings confirm what GPs know – those serving in more socioeconomically disadvantaged communities see higher numbers of patients with these common chronic conditions.
 
‘GPs are managing these conditions, and also doing the preventive care – smoking cessation, screening, immunisation – that prevents the worst consequences of these conditions,’ he told newsGP.
 
‘The concerning part is that there is no funding directed according to socioeconomic need. We know that these conditions will require longer appointments, but these aren’t funded well.
 
‘Bulk billing acts as a ceiling to funding for practices where patients need them the most. There’s no funding for action on social determinants of health, such as housing quality, overcrowding, food affordability, air quality, etc, which could be done by Primary Health Networks, for example.’
 
Dr Senior said ‘there needs to be a socioeconomic disadvantage lens applied to funding general practice and primary care’.
 
‘We know that the GP workforce tends to work in more disadvantaged areas, and we also know that GP supply, and having a health system based around the comprehensive, co-ordinated, community-based, patient-centred care that GPs provide, is the way to improve outcomes for people,’ he said.
 
‘If resources aren’t specifically targeted based on socioeconomic disadvantage, then these outcomes will not improve. This means funding for more complex care and preventive care, and funding for local action on housing, food affordability and other social causes of poor health.’
 
Dr Gong said it is important that socioeconomic drivers of health inequities continue to be a clear focus.
 
‘For example, in this study, differences in disease risk by the area-based Index of Relative Socio-economic Disadvantage highlight how factors like healthcare access play a key role in reducing risk and narrowing inequities,’ she said.
 
‘Coordinated action across the healthcare system and beyond is essential to making progress.’
 
Dr Senior added that while attention in health policy is often focussed on the ageing population, this study shows that attention is needed on social disadvantage as well.
 
‘Many of the problems we think of as problems of ageing are happening earlier in disadvantaged communities,’ he said.

‘The study also highlights some gender differences in the way that disadvantage plays out for health outcomes, and this will be important to pay attention to in policy responses too.’
 
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chronic disease poverty socioeconomic status