People with low wealth and income have up to 85 percent higher risk of receiving risky medication compared to the most affluent Danes.

This is shown by a comprehensive national study led by researchers from Aarhus University, published in the journal PLOS Medicine.

"Our study showed that economic conditions have the strongest association with inappropriate medication in Denmark. One explanation could be that economy is probably the most defining factor for our social position in society and thus also the most decisive for our starting point when encountering the healthcare system," says postdoc Amanda Paust from the Department of Public Health, who is the main author of the study.

Education and networks affect medication

The study, which combines data from a large health survey from 2017 with national registers, has used sociologist Pierre Bourdieu's theory of capital forms to analyze the problem from multiple angles.

And the study showed that all three forms of capital – economic, cultural, and social – influence the quality of patient care in Denmark.

The study showed that people with low education levels have a 66 percent higher risk of receiving problematic medication, while people with limited social networks have approximately 35 percent higher risk. Immigrants and people who live alone are also more vulnerable.

"We used Pierre Bourdieu's theory to understand how different resources affect treatment quality. For example, we showed that a weak social network increases the risk of inappropriate medication, which is often overlooked in scientific studies of social inequality," says Amanda Paust.

Overtreatment a bigger problem than undertreatment

Particularly noteworthy is that social inequality is primarily linked to overtreatment – when patients receive medication that potentially can do more harm than good – rather than undertreatment, where patients do not receive medication they could benefit from.

The inequality persists even when researchers account for differences in disease patterns between social groups. In total, 14.7 percent of participants received at least one form of risky medication.

"We could see that inequality in treatment quality exists, even when we compare people with comparable health problems. This shows once again that a universal system does not automatically create equality in health," says Amanda Paust.

Doctors can make a difference

The researchers point to general practitioners as key figures in creating more equality in the quality of medical treatment.

"General practitioners are important because they prescribe the majority of all medication in Denmark and often have contact with us citizens. Inequality can be reduced with tailored services to those with the greatest needs. Research shows that longer consultations, continuity in the relationship with one primary care provider, or better communication about the treatment process can make a difference," says Amanda Paust.

The research team is now working further to investigate how specific interventions can reduce the risk of inappropriate treatment in socially vulnerable groups.

Behind the research – more information

• Study type: Cross-sectional study based on registers and questionnaire data
• Collaborators: Research Unit for General Practice, DEFACTUM, National Institute of Public Health, Trinity College Dublin, Royal College of Surgeons in Ireland
• External funding: The Foundation for General Practice
• Conflict of interest? No
• Link to scientific article: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004473

Contact

Postdoc Amanda Paust
Aarhus University, Department of Public Health
Phone: 87167909
amasa@ph.au.dk

This article has been partially translated using AI.