Background <p>Reducing inequalities among patients with inherited, chronic, and complex disorders requiring lifelong care remains a global public health priority. Despite medical advances, inequalities in healthcare access and quality persist for patients with β-thalassaemia. This study examined the associations between socio-economic indicators at the individual and country levels and clinical outcomes in β-thalassaemia patients using data from the International Thalassaemia Collaborative Assessment Patient Survey.</p> Study design and methods <p>Data from 971 patients across 45 countries were analysed. Individual-level socio-economic status (SES) was assessed through patients’ educational attainment and employment status, while country-level SES was represented by the Human Development Index and the World Bank Income classification. Clinical outcomes included pre-transfusion haemoglobin levels, serum ferritin concentration, cardiac T2* score, and liver iron concentration. Inequalities were quantified using the Slope Index of Inequality, representing absolute differences in outcomes between patients of lowest and highest SES.</p> Results <p>All SES indicators were positively associated with better clinical outcomes. Higher education and full-time employment corresponded to better levels of haemoglobin, ferritin, cardiac, and liver iron measures. Similarly, patients living in higher-income countries had better clinical measures compared to those living in lower-income countries. These findings indicate that socio-economic advantage is linked with improved disease management and monitoring quality.</p> Discussion <p>Socio-economic determinants influence the clinical outcomes of transfusion-dependent β-thalassaemia patients, which in turn affect their social integration and quality of life. Reducing these disparities requires investment in equitable healthcare systems, multidisciplinary care, and disease-specific public health policies.</p>