Socioeconomic Inequalities, Health Insurance and Functional Difficulty among Jamaican Adults: Evidence from the 2023 Jamaica Survey of Living Conditions

Abstract

Socioeconomic disadvantage is widely associated with poorer health. Yet comparatively little contemporary evidence has examined whether household economic position and health-insurance coverage independently predict functional difficulty among Jamaican adults after demographic and social differences are considered. This study used cross-sectional secondary data from the 2023 Jamaica Survey of Living Conditions (JSLC) to examine functional health among 3,312 adults aged 18 years and older, with descriptive statistics, Pearson's chi-square tests, Cramer's V and multivariable binary logistic regression employed to assess socioeconomic, demographic and insurance-related differences. Functional difficulty was reported by 21.9% of respondents, 79.2% were uninsured; insurance coverage displayed a pronounced socioeconomic gradient, increasing from 9.6% among adults in Quintiles 1-2 to 31.4% among those in Quintiles 4-5, ?²(2) = 198.108, p< .001, Cramer's V = .245, whereas functional health was not significantly associated with socioeconomic group at the bivariate level, ?²(6) = 6.697, p = .350. The adjusted logistic model was statistically significant, ?²(13) = 686.541, p< .001, Nagelkerke R² = .290, and identified age, sex, education and single union status as independent predictors; socioeconomic group and health insurance were not independently associated with functional difficulty. These findings suggest that functional-health inequality in contemporary Jamaica cannot be reduced to current household economic position or insurance status alone and instead reflects a life-course structure in which ageing, female disadvantage and educational stratification appear especially important, with implications for disability prevention, healthy ageing and socially differentiated health policy.