Socioeconomic and lifestyle determinants of blood glucose screening in Malaysia

Characteristics of the survey respondents are presented in Table 1. Less than one third of the respondents had their blood sugar measured in the last 12 months. The average age of the respondents is about 43 years. The majority of the respondents were female. A large proportion of the overall sample were married. Slightly more than half of the respondents were Malay.

About half of the respondents were in the low income group, followed by those in the lower-middle, upper-middle, and high income groups. The sample comprised an almost equal distribution of urban and rural dwellers. Approximately one fifth of the respondents’ immediate family members have diabetes. A minority of the respondents were smokers (21.3%). The BMI breakdown comprised about one sixth of the respondents who are obese, about one third overweight, and about one third of normal weight.

Results of the logistic regression analysis of using blood sugar test are illustrated in Table 2. About 72.80% of the outcomes were correctly predicted by the model showing good fit. Additionally, the results of LR and HL tests indicate that the model fits the data very well. Age was found to be positively associated with the likelihood of using blood sugar test (OR: 1.045; 95% CI: 1.034, 1.055). Married individuals have higher odds of using blood sugar testing than unmarried individuals (OR: 1.396; 95% CI: 1.033, 1.887). Compared to non-Malays, Malays are more likely to use blood sugar testing (OR: 1.254; 95% CI: 1.036, 1.519).

Higher odds of using blood sugar test are observed among individuals who are in high, upper-middle, and lower-middle income groups. Smokers show lower odds of using blood sugar test than non-smokers. Individuals who are obese, overweight, and normal weight are more likely to use blood sugar test than individuals who are underweight.

The nationally representative sample used in the present study allows an in-depth analysis of the socioeconomic and lifestyle factors associated with use of blood glucose screening. Applying a rigorous statistical model, the results show that age, marital status, ethnicity, income, smoking, and BMI are significantly correlated with use of blood glucose screening. Specifically, there exist positive relationships between the likelihood of using blood glucose screening and older individuals, being married, Malays, higher income earners, non-smokers, and being obese, overweight, and normal weight.

The findings of the present study suggest that older individuals are more likely to use blood glucose screening than their younger counterparts, which are somewhat consistent with those of previous studies conducted in Taiwan. For example, Hsieh and Lin [16] use data from the Taiwan Provincial Institute of Family Planning and find that older elderly people are more likely to use urine, blood pressure, and blood sugar tests than their younger peers. Tian et al [22] applied the 2003 Survey of Health and Living Status of the Elderly in Taiwan and observed a positive relationship between older individuals and use of preventive medical care services. The reasons for this outcome are straightforward. Because older individuals are more prone to suffering from diseases because of the biological process of aging, they are more motivated to use health screening. Young people also tend to take their health for granted, and consequently ignore the importance of health screening [23]. Therefore, we suggest that policy makers pay special attention to young people rather than the elderly, if the goal of increasing the utilization of health screening, particularly blood glucose screening is to be achieved.

Married individuals are more likely to use blood glucose screening than unmarried individuals. This finding is somewhat consistent with that of Deb [24]. We considered family-level variables in their analysis and found that presence of a spouse can significantly increase the probability of using blood pressure and cholesterol tests. More recent studies by Tian et al. [22] and Cheah [23] share similar findings. In particular, they find that marriage is positively associated with a higher likelihood of using health screening. Taken these findings together, we can conclude that married individuals display different decisions to use health screening from unmarried individuals given the presence of spouses or extended family commitments. As suggested by Cheah [23], married people tend to carry more responsibilities to look after their family than unmarried people, and are thus more aware of their own health. In terms of policy implication, an intervention strategy specifically targeted at the unmarried adults may be effective.

Ethnicity is found to be significantly associated with use of health screening, because Malays are more likely to use blood glucose screening than non-Malays. Dunn and Tan [10], Dunn et al. [11], and Dunn and Tan [12] found significant ethnic differences in use of cancer screening such as Pap smear and mammogram. Based on the current finding regarding ethnicity, one can conclude that Malays, the ethnic majority in Malaysia, are more aware of the benefits of using blood glucose screening than non-Malays. Perhaps, this is because information regarding health screening is often advertised to the public using Malay, the official language of Malaysia. However, given the limited availability of secondary data used in the present study, a better understanding of this explanation may be achieved by an in-depth qualitative study.

The findings regarding income are consistent with those of previous studies, which found income increases the use of health screening. For instance, Yi [25] uses a sample of Vietnamese women in Western Massachusetts and finds that women with lower income are less likely to use a Pap test than their higher income peers. Using similar outcome variables, Zhang et al. [17] found that women with a higher family income are more likely to use a Pap test than their peers with lower family income. Similar findings were reported by Abraido-Lanza et al. [18] after an examination of data from a National Health Interview Survey. That financial constraint is a high barrier to use of health screening may explain these findings, at least in part. Because expenditure on preventive medical care is unlikely to be paid by insurance or any third-party, especially in Malaysia, low income earners may tend to find health screening unaffordable. Therefore, in an effort to promote the use of health screening, particularly blood glucose screening among the poor, the government should consider subsiding the services at various hospitals and clinics.

Surprisingly, education was found to have insignificant relationship with use of blood glucose screening, which contradicts the findings reported by Kenkel [15] that education can increase an individual’s likelihood of using health screening to improve health. The present study did not show any geographical differences in use of blood glucose screening, which is somewhat inconsistent with Zhang et al. [17], who find that fewer rural than urban women undergo mammograms. Although Cheah and Tan [26] observed that a family history of chronic diseases such as hypertension, heart diseases and stroke can affect health-related behavior, the present study finds no significant relationship between presence of family history of diabetes and utilization of blood glucose screening.

The findings regarding lifestyle factors are interesting. On one hand, we found that smokers are less likely to use blood glucose screening than nonsmokers, which is consistent with findings of Lairson et al. [27] and Lin [21] who used a national sample of women veterans in the US and the National Health Interview Survey of Taiwan, respectively. Both these studies suggest that smoking significantly reduces the probability of using breast cancer screening. The notion is that smokers are generally more irrational and less concerned about their own health than nonsmokers and consequently display a lower preference for health investment, such as use of preventive medical care [21, 27]. On the other hand, we found that BMI has a positive effect on use of blood glucose screening. This may be because obese and overweight individuals are often told by health professionals that they have a high risk of developing various diseases. Therefore, they may be more willing to make better use of health screening to avoid diseases compared with their less corpulent peers. Additionally, individuals who are underweight may tend to be optimistic that they are unlikely to acquire diseases, and thus ignore the importance of health screening. An important implication of these findings is that public health authorities should make a concerted effort to promote use of blood glucose screening among smokers and underweight individuals.

The present study provides empirical evidence regarding nonusers of blood glucose screening. Specifically, young people, the unmarried, non-Malays, low income earners, smokers, and underweight individuals are identified as the non-users. Some brief discussions of these findings are in order. First, the young tend to have the perception that their risk of developing diabetes is low, and consequently ignore the importance of using blood glucose screening. Therefore, policies directed toward increasing health awareness among young people may be effective in promoting use of blood glucose screening. For instance, that diabetes is not a disease necessarily associated with the elderly should be well-advertised. Second, because of weak household commitment, unmarried individuals are unlikely to take their own health seriously. As a consequence, they tend to put a low effort into disease prevention. This finding implies that promoting marriage between young adults may be a good strategy for promoting their use of blood glucose screening. Third, the finding that non-Malays tend to be the nonusers of blood glucose screening reflects cultural differences in adoption of preventive measures against diabetes. Therefore, a public policy targeted towards encouraging use of blood glucose screening among non-Malays through language-based mass media may be effective. Fourth, low income earners tend to encounter financial difficulties, and thus lack the capability or priority to purchase health screening services. An implication of this finding is that intervention strategies that provide the poor with cost-reduced health screening services may help to increase the use of blood glucose screening. Finally, that smokers and underweight individuals are relative nonusers of blood glucose screening is not surprising. This may be because smokers are less conscious of their own health, whereas underweight individuals are optimistic about their health outcomes. As a result, they have a low tendency to undergo health examination. Policy recommendation in light of this finding is that government should introduce nationwide health awareness programmes with the aim of delivering information on disease prevention to smokers and underweight individuals.

Several inherent limitations of this secondary analysis of cross-sectional data are noted. First, numerous variables potentially affecting the use of health screening, such as, price of medical care, household size, and presence of children in a family are not considered in the present analysis. Second, although the data used in the present study is representative, it is not the most recent survey conducted by the Malaysian Ministry of Health. Despite these limitations, the present study sheds new light on the relationship between use of blood glucose screening and socioeconomic, and lifestyle factors.

In efforts to encourage the public to use blood glucose screening, it is essential to have a wide knowledge of which groups of individuals use or do not use the services. Consistent with previous studies conducted in developed countries, the present study suggests that socioeconomic and lifestyle factors play an important role in the decision of people to use blood glucose screening. Therefore, appropriate direct intervention measures are needed to guarantee promising health outcomes.