Socioeconomic inequalities in self-rated health, illness, and Hospitalization in Ecuador from the ENSANUT-2018 Survey

Abstract

Background Social inequalities in health remain a critical public health concern globally, with marginalized populations often experiencing worse health outcomes. In Ecuador, ecological studies have documented disparities in mortality and morbidity linked to socioeconomic factors. Yet, the relationship between socioeconomic determinants and self-reported health outcomes at the individual level has not been thoroughly examined. This study comprehensively assesses health inequalities across different social strata in Ecuador.

Methods A secondary analysis of the 2018 National Health and Nutrition Survey was conducted. This population-based survey includes economic and health information of 168 747 Ecuadorians (49% men and 51% women). Successive regression models were used to estimate the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII), and the odds ratio (OR) of poor self-rated health (SRH), hospitalization in the last year, and illness in the last 30 days. Health inequalities were described by age, sex, self-reported ethnicity, education, quintiles of wealth, and area (urban/rural).

Results The prevalence of poor SRH was higher in women (25%) than in men (23%). A strong socioeconomic gradient was observed: in the fully adjusted model, individuals in the poorest wealth quintile were four times more likely to report poor SRH (RII, 3.88; 95% confidence interval [CI], 3.31–4.54; SII, 23%; 95% CI, 20–26) than those in the highest wealth. Similarly, those with no education were almost three times more likely to report poor SRH (RII, 2.69; 95% CI, 2.35–3.08; SII, 18%; 95% CI, 15–20) than those with the highest education. Inequalities in self-reported illness were less consistent, while hospitalizations showed no association with socioeconomic determinants, suggesting potential barriers in healthcare access among disadvantaged groups.

Conclusion There are significant inequalities in SRH across ethnic groups, economic, and educational lines in Ecuador, exceeding disparities reported in other countries. The discrepant findings highlight the need for continuous health monitoring and targeted policies addressing structural determinants to mitigate health inequalities.