WITHDRAWN: Assessing Equity in Unmet Needs for Non-Communicable Diseases Services in Saudi Arabia Using a National Household Survey (2019) 

Abstract

Background: Saudi Arabia is implementing a comprehensive health system transformation in health services provision, governance, and financing that was announced in 2016. Given the high burden of non-communicable diseases (NCDs), a key objective of the transformation is to integrate NCD prevention and treatment into primary care. The study objectives are to assess primary care service use for treatment of NCDs, to quantify existing inequities in preventive services utilization, and to identify regional and socioeconomic factors associated with these inequities. Methods: Using the 2019 Kingdom of Saudi Arabia World Health Survey, multivariable logistic regression models were conducted to identify significant predictors of utilization of primary care services for prevention and treatment of NCDs, unmet health care needs among those who reported a diagnosis of diabetes, hypertension, or dyslipidemia, and breast and cervical cancer screenings. Results: Among those who reported having an NCD diagnosis, living in a high-income household was associated with a lower probability of having an unmet need in comparison to those living in lower-income households. Furthermore, adults residing in rural areas were less likely to have an unmet need compared to residents in urban areas (OR 0.58, p=0.029). Not perceiving a need for healthcare within the last 12 months was associated with three times the probability of unmet need in comparison to those with a subjective need for healthcare (p<0.001). All regions had lower probability of ever having a mammogram when compared to the central regions around Riyadh. Women who had more than a secondary level of education had five times the odds of undergoing cervical cancer screening and three times the likelihood of ever having a mammogram (P=0.012, p=0.02). Middle (OR 1.99, P=0.026), upper middle (OR 3.47, p<0.001), and high-income households (OR 2.59, p<0.001) had increased probability of having a cervical cancer screening compared to lower-income households. Conclusions: Inequities in NCD treatment and prevention services’ utilization in Saudi Arabia are strongly associated with region of living, population density, wealth, income, education and perceived need for health care. More research is needed to better understand the extent of unmet primary care needs for NCD and how to address the underlying contributing factors to access inequities.