Undiagnosed Dysglycemia and Socioeconomic Status in Argentina: A Paradoxical Gradient in the 2018 National Survey of Risk Factors

BackgroundUndiagnosed diabetes represents a major challenge for health systems worldwide. While low socioeconomic status is typically associated with reduced healthcare access, the relationship between socioeconomic position and diabetes detection remains poorly characterized in Latin American settings with fragmented health systems. MethodsWe analyzed data from 4,409 Argentine adults who underwent capillary glucose measurement in the Third Step of the 2018 National Survey of Risk Factors. Among 471 individuals with elevated glucose ([≥]110 mg/dL), we examined the association between household income quintile and undiagnosed status using multivariable logistic regression, adjusting for age, sex, health coverage type, education, body mass index, physical activity, and smoking. ResultsContrary to expectations, undiagnosed dysglycemia increased with socioeconomic status: from 45.8% in the lowest quintile to 67.8% in the fourth quintile, with a slight decrease to 61.1% in the highest quintile. After full adjustment, each higher income quintile was associated with 22% greater odds of remaining undiagnosed (OR=1.22; 95% CI: 1.04-1.44; p=0.014). Notably, enrollment in public assistance programs (Plan Estatal) was associated with substantially lower odds of undiagnosed dysglycemia compared to social security coverage (OR=0.27; 95% CI: 0.09-0.79). Results were robust across multiple weighting specifications. ConclusionsHigher socioeconomic status paradoxically increases the likelihood of undiagnosed dysglycemia in Argentina, challenging conventional assumptions about healthcare access. Targeted public programs appear effective at identifying cases among vulnerable populations, while gaps persist in higher-income groups. These findings suggest that diabetes screening strategies should not overlook populations traditionally considered to have adequate healthcare access.