Priority and prejudice: does low socioeconomic status bias waiting time for endoscopy? A blinded, randomized survey

Abstract

Introduction: An unwanted socioeconomic health gap is observed in Western countries with easily accessible, government-financed health care systems. Survival rates from several malignancies differ between socioeconomic clusters and the disparities remain after adjusting for major co-morbidities and health related behavior. The possibility of biased conduct among health care workers has been proposed as a contributing factor, but evidence is sparse.

Methods: A blinded, randomized online questionnaire survey was conducted among specialists in gastroenterology in Norway. Each respondent was asked to give priority for colonoscopy to three different referrals. By randomized sequence, half the referrals contained a discreet piece of information indicating low socioeconomic status (SES). The SES information given was focused on known low-status clusters in Norway, namely the morbidly obese and receivers of disability pensions.

Results: There were 107 respondents giving a response rate of 67%. A lower priority was consistently given to the referrals containing information on low SES, but the difference only reached statistical significance (p = .018) for one of the referrals.

Conclusion: Information on low SES may influence how referrals for endoscopy are prioritized.

Keywords:

• Socioeconomic bias
• health disparity
• biased priority
• anti-obesity prejudice

Acknowledgements

Associate professor Bjørn Straume has contributed to the statistical analysis. Inger Sperstad has constructed and performed the QuestBack^® survey.

Disclosure statement

Kristoffer Lassen has on one occasion received a speaker´s fee from Nestlé (April 2016). Lars Aabakken and Linn Saave Nymo have declared no competing interests.