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Clinical Trial
, 13 (6), e0199170
eCollection

Sociodemographic Determinants and Health Outcome Variation in Individuals With Type 1 Diabetes Mellitus: A Register-Based Study

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Clinical Trial

Sociodemographic Determinants and Health Outcome Variation in Individuals With Type 1 Diabetes Mellitus: A Register-Based Study

Carl Willers et al. PLoS One.

Abstract

Background: Socioeconomic status, origin or demographic attributes shall not determine the quality of healthcare delivery, according to e.g. United Nations and European Union rules. Health equity has been defined as the absence of systematic disparities and unwarranted differences between groups defined by differences in social advantages. A study was performed to investigate whether this was applicable to type 1 diabetes mellitus (T1D) care in a setting with universal, tax-funded healthcare.

Methods: This retrospective registry-study was based on patient-level data from individuals diagnosed with T1D during 2010-2011 (n = 16,367) in any of seven Swedish county councils (covering ~65% of the Swedish population). Health equity in T1D care was analysed through multivariate regression analyses on absolute HbA1c level at one-year follow-up, one-year change in estimated glomerular filtration rate (eGFR) and one-year change in cardiovascular risk score, using selected sociodemographic dimensions as case-mix factors.

Results: Higher educational level was consistently associated with lower levels of HbA1c, and so was being married. Never married was associated with worse eGFR development, and lower educational level was associated with higher cardiovascular risk. Women had higher HbA1c levels than men, and glucose control was significantly worse in patients below the age of 25.

Conclusion: Patients' sociodemographic profile was strongly associated with absolute levels of risk factor control in T1D, but also with an increased annual deterioration in eGFR. Whether these systematic differences stem from patient-related problems or healthcare organisational shortcomings is a matter for further research. The results, though, highlight the need for intensified diabetes management education and secondary prevention directed towards T1D patients, taking sociodemographic characteristics into account.

Conflict of interest statement

CW, HI and BJ are employed by Ivbar Institute, a research company specialized in health care governance and analysis of health care data. The other authors state no disclosures.

Figures

Fig 1
Fig 1. Multivariate regression analysis on HbA1c levels.
Coefficient point estimates and their 95% confidence intervals.
Fig 2
Fig 2. Multivariate regression analysis on one-year change in eGFR.
Coefficient point estimates and their 95% confidence intervals.
Fig 3
Fig 3. Multivariate regression analysis on one-year change in CVD risk score.
Coefficient point estimates and their 95% confidence intervals.

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References

    1. Swedish Health and Medical Services Act (Hälso- och sjukvårdslagen). In: Swedish Government; 1982.
    1. Closing the gap in a generation: health equity through action on the social determinants of health Final Report of the Commission on Social Determinants of Health. World Health Organization; 2008
    1. Health inequalities in the EU—Final report of a consortium 2013. Consortium lead: Sir Michael Marmot. European Union
    1. Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health 2003;57:254–258 doi: 10.1136/jech.57.4.254 - DOI - PMC - PubMed
    1. Oliver A, Mossialos E. Equity of access to health care: outlining the foundations for action. J Epidemiol Community Health 2004; 58(8): 655–8. doi: 10.1136/jech.2003.017731 - DOI - PMC - PubMed

Publication types

Grant support

Funding for this study was provided by Sveus, a research collaboration with seven Swedish regions developing systems for value-based monitoring and reimbursement of healthcare. Partial funding from Forte programme grant 2012/1688 ("Value and choice") is gratefully acknowledged.
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