Do social inequalities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes? A systematic review

Abstract

The major increase in the prevalence of diabetes mellitus (DM) has led to the study of social inequalities in health-care. The aim of this study is to establish the possible existence of social inequalities in the prevention, diagnosis, treatment, control and monitoring of diabetes in Organisation for Economic Co-operation and Development (OECD) countries which have universal healthcare systems. We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for all relevant articles published up to 15 December 2007. We included observational studies carried out in OECD countries with universal healthcare systems in place that investigate social inequalities in the provision of health-care to diabetes patients. Two independent reviewers carried out the critical assessment using the STROBE tool items considered most adequate for the evaluation of the methodological quality. We selected 41 articles from which we critically assessed 25 (18 cross-sectional, 6 cohorts, 1 case-control). Consistency among the article results was found regarding the existence of ethnic inequalities in treatment, metabolic control and use of healthcare services. Socioeconomic inequalities were also found in the diagnosis and control of the disease, but no evidence of any gender inequalities was found. In general, the methodological quality of the articles was moderate with insufficient information in the majority of cases to rule out bias. This review shows that even in countries with a significant level of economic development and which have universal healthcare systems in place which endeavour to provide medical care to the entire population, socioeconomic and ethnic inequalities can be identified in the provision of health-care to DM sufferers. However, higher quality and follow-up articles are needed to confirm these results.

Association of arsenic, cadmium and manganese exposure with neurodevelopment and behavioural disorders in children: A systematic review and meta-analysis

“…This tool was initially developed to assess clarity in communicating research results in observational studies, and it has been used in recent systematic reviews to assess the methodological quality of observational studies (Olmos et al, 2008;Scales and Dahm, 2008;Ricci-Cabello et al, 2010).…”

Health Disparities in Endocrine Disorders: Biological, Clinical, and Nonclinical Factors—An Endocrine Society Scientific Statement

“…Diabetic individuals in the United Kingdom living in high immigrant areas were less likely to be prescribed oral diabetic agents (340). In New Zealand, "other Asians" were less likely to be prescribed aspirin, antihypertensives, or insulin compared with Europeans, and Maoris and Pacific Islanders were less likely treated with diet changes and statins compared with Europeans (340). Studies have been mixed regarding the use of preventive services among minority populations in the Organization for Economic Cooperation and Development countries, with some showing great use of ophthalmological screening and preventive services (e.g.…”

“…Socioeconomic status is also associated with poor metabolic control in non-U.S. countries. In Germany, the United Kingdom, and Spain, individuals of lower socioeconomic status had higher Hb A1c , worse dyslipidemia, and higher rates of obesity (340). Even independent of race, sex, and lifestyle factors, allostatic load is negatively associated with education and income, suggesting one potential mechanism through which socioeconomic stress may increase metabolic disease risk (341).…”

“…In a meta-analysis of studies conducted in the Organization for Economic Cooperation and Development countries with universal health care systems, certain race/ethnic groups were not adequately controlled (340). In New Zealand, Europeans had better glycemic control than other ethnic groups, and in the United Kingdom, non-European women with gestational diabetes had worse glycemic control than their European counterparts (340).…”

“…Even in countries with universal health care, race/ethnic inequalities exist in the quality of care that patients with diabetes receive. Diabetic individuals in the United Kingdom living in high immigrant areas were less likely to be prescribed oral diabetic agents (340). In New Zealand, "other Asians" were less likely to be prescribed aspirin, antihypertensives, or insulin compared with Europeans, and Maoris and Pacific Islanders were less likely treated with diet changes and statins compared with Europeans (340).…”