Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study

BackgroundSocioeconomic 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.MethodsThis 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.ResultsHigher 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.ConclusionPatients’ 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.研究背景：根据联合国及欧盟相关规定，社会经济地位、族裔或人口统计学特征不应决定医疗服务质量。健康公平被定义为：在因社会优势差异而划分的群体之间，不存在系统性差异与无正当理由的差别。本研究旨在探究这一原则是否适用于全民税收资助医疗体系下的1型糖尿病（type 1 diabetes mellitus, T1D）诊疗服务。 研究方法：本研究为回顾性登记研究，数据来源于瑞典7个郡议会（覆盖约65%瑞典总人口）内2010-2011年确诊的16367名1型糖尿病患者的个体水平数据。本研究以选定的社会人口学维度作为病例组合校正因素，通过多因素回归分析，对1年随访时的糖化血红蛋白（glycated hemoglobin A1c, HbA1c）绝对水平、估算肾小球滤过率（estimated glomerular filtration rate, eGFR）1年变化量及心血管风险评分1年变化量进行分析，以评估1型糖尿病诊疗中的健康公平性。 研究结果：较高的受教育程度与较低的糖化血红蛋白水平持续相关，已婚状态同样如此。未婚状态与更差的估算肾小球滤过率变化趋势相关，而较低的受教育程度则与更高的心血管风险相关。女性患者的糖化血红蛋白水平高于男性，且25岁以下患者的血糖控制情况显著更差。 研究结论：1型糖尿病患者的社会人口学特征与危险因素控制的绝对水平显著相关，同时也与估算肾小球滤过率的年度恶化程度增加相关。上述系统性差异究竟源于患者自身相关问题还是医疗服务体系的结构性缺陷，尚需进一步研究予以阐明。不过本研究结果提示，需针对1型糖尿病患者开展强化糖尿病管理教育与二级预防工作，并充分考虑其社会人口学特征差异。