Persistent socioeconomic and ethnic inequalities in unmet need for NCD diagnosis and treatment in Viet Nam, 2015–2021

Large gaps in the detection and treatment of noncommunicable diseases (NCDs) persist globally, particularly in low- and middle-income countries progressing toward universal health coverage. Despite expanded insurance and primary care reforms, the magnitude and equity of unmet NCD care needs in Viet Nam remain unclear. We analyzed nationally representative WHO STEPS surveys in 2015 (n = 1,300) and 2021 (n = 2,276) to assess unmet need for diagnosis and treatment of hypertension, diabetes, and dyslipidemia and to examine inequalities by socioeconomic status, education, and ethnicity. Unmet need for diagnosis and unmet need for treatment were analyzed as separate primary outcomes. Inequalities were quantified using the Erreygers Concentration Index (ECI), while absolute and relative inequalities were assessed using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII), with survey weights applied to prevalence and inequality estimates. Unmet need for diagnosis remained high, increasing from 82.2% in 2015 to 84.5% in 2021, while unmet need for treatment was higher but changed little, from 91.9% to 90.9%. Dyslipidemia showed the largest gaps. Ethnic inequalities persisted across survey years, with RII values ranged from 1.25 (95% CI: 1.14-1.36) to 1.29 (95% CI: 1.14-1.46) for unmet diagnosis and from 1.12 (95% CI: 1.03-1.22) to 1.17 (95% CI: 1.10-1.24) for unmet treatment. Socioeconomic inequalities in diagnosis also persisted, with RII values of 0.80 (95% CI: 0.73-0.89) in 2015 and 0.90 (95% CI: 0.84-0.96) in 2021, whereas education-related inequalities observed in 2015 were no longer apparent in 2021. All three inequalities measures showed consistent patterns. Viet Nam continues to face substantial unmet needs for NCD diagnosis and treatment, with persistent ethnic and socioeconomic disparities. Equity-oriented primary care and NCD services are needed to support more equitable progress toward universal health coverage.