Socioeconomic inequalities significantly impact access to healthcare services for individuals with type 2 diabetes mellitus (T2DM). This study investigates these inequalities in Iran, focusing on factors such as asset, sex, urban–rural residence, age, education, employment status, and marital status.

Cross-sectional study.

This study used data from the national ‘Diabetes Care (DiaCare)’ study, a population-based survey conducted from 2018 to 2020 in Iran.

Socioeconomic status (SES) was assessed using Principal Component Analysis (PCA) based on assets. Socioeconomic inequalities in access to physicians, pharmacies and laboratories were measured using the Concentration Index (CI) and Erreygers Corrected Concentration Index (ECI). Decomposition analysis was performed using a probit regression model to assess the contributions of various factors to the observed inequalities.

Among 13 315 patients with T2DM, 5.8% lacked access to physicians, 6.8% to pharmacies and 8.7% to laboratories. The CI was positive and statistically significant for access to physicians (0.0614), pharmacies (0.0787) and laboratories (0.0875), indicating better access concentrated among higher SES individuals. Urban residents had the largest positive marginal effects on access to physicians (0.032), pharmacies (0.078) and laboratories (0.053), with percentage contributions of 13.21%, 23.23% and 17.39%, respectively. Higher asset quintiles showed substantial contributions to inequalities, with the highest quintile contributing 10.5% to physician access inequality, 9.68% to pharmacy access and 9.16% to laboratory access. Education level also positively impacted access, with high school education contributing 0.64% and college education 0.52% to access inequalities. Sex differences showed a negative marginal effect for women, indicating slightly lower access.

Socioeconomic factors, particularly asset, residence and education, significantly impact access to healthcare services for patients with T2DM in Iran. Policies should focus on reducing barriers to healthcare access, especially for lower SES and rural populations.

Despite the rise in popularity of e-cigarette smoking or ‘vaping’, its long-term health consequences are still being investigated. In particular, it is unclear what impact e-cigarette use has on aerobic performance and exercise capacity. This information has important implications both for tobacco smokers as a harm reduction approach, and youth and young adults who are increasingly turning to e-cigarettes recreationally. Thus, this review aims to systematically evaluate the literature surrounding the effects of regular e-cigarette use on markers of cardiorespiratory fitness and physical activity.

This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. A systematic search was undertaken in October 2024, using the defined population, intervention, comparison, outcomes, study time framework to identify all relevant articles. Studies will be eligible if they include individuals who use e-cigarette products, assess regular e-cigarette use as an exposure, compare to a group of non-users and report outcomes related to measures of cardiorespiratory fitness (eg, VO2max, 6 min walk test) or physical activity (eg, sport participation, meeting weekly physical activity guidelines), regardless of study duration. Searched databases will include PubMed/Medline, Cochrane Library and Embase, with no restriction to date or language of publication. Two reviewers will carry out the title and abstract screening, full text review and data extraction. Risk of bias will be assessed using the Newcastle-Ottawa Scale for non-randomised studies and the Cochrane Risk of Bias Tool (v2) for randomised studies. Study heterogeneity will be assessed using the Q and I² statistic tests. Efforts will be made to conduct a meta-analysis if sufficient data and homogeneity are present. Otherwise, a narrative synthesis will be conducted, focusing on common themes, subgroups and sources of variability.

Ethics approval is not required for this review of previously published or presented data. The results of the review will be disseminated via conference presentations and peer-reviewed publication. Moreover, results of this review may inform public health recommendations and identify areas in the field where further research is needed.

CRD420250589685.