Social disparities in diabetes care: a general population study in Denmark

Abstract

ObjectiveWe investigated the association between socioeconomic factors and the attainment of treatment goals and pharmacotherapy in patients with type 2 diabetes in Denmark.DesignA cross-sectional population study.SettingThe municipality of Naestved, Denmark.SubjectsWe studied 907 patients with type 2 diabetes identified from a random sample of 21,205 Danish citizens.Main outcome measuresThe proportion of patients who were not achieving goals for diabetes care based on their HbA1c, LDL-cholesterol, blood pressure, and lifestyle, and the proportion of patients who were treated with antihypertensive and cholesterol- and glucose-lowering medication.MethodsWe investigated the association of the socioeconomic factors such as age, gender, education, occupation, income, and civil status and attainment of treatment goals and pharmacotherapy in logistic regression analyses. We investigated effect modification of cardiovascular disease and kidney disease.ResultsMiddle age (40–65 years), low education level (i.e. basic schooling), and low household income (i.e. less than 21,400 € per year) were associated with nonattainment of goals for diabetes care. The association of socioeconomic factors with attainment of individual treatment goals varied. Patients with low socioeconomic status were more often obese, physically inactive, smoking, and had elevated blood pressure. Socioeconomic factors were not associated with treatment goals for hyperglycemia. Socioeconomic factors were inconsistently associated with pharmacotherapy. There was no difference in contacts to general practitioners according to SES.ConclusionsIn a country with free access to health care, the socioeconomic factors such as middle age, low education, and low income were associated with nonattainment of goals for diabetes care.Key pointsMiddle age, low education, and low income were associated with nonattainment of goals for diabetes care, especially for lifestyle goals.Patients with low socioeconomic status were more often obese, physically inactive, smoking, and had elevated blood pressure.Association of socioeconomic factors with pharmacotherapy was inconsistent.

Socio-demographic determinants and effect of structured personal diabetes care: a 19-year follow-up of the randomized controlled study diabetes Care in General Practice (DCGP)

“…The present findings suggest that an intervention with structured personal care does not give rise to more social inequity in use of the health care system, as has been described in other studies [ 13 , 21 ]. Thus the results do not confirm results from studies of the general population showing that the number of consultations at the GP increases with decreasing socio-economic status [ 15 , 32 ]. The fact that socio-economic differences in mortality and morbidity persist, despite formally equal access to the public health care system, could be due to different use of specialist care as suggested by others [ 17 , 20 ], but this does not seem to be the case for the intervention in our study.…”

“…The presented benefit of structured personal care on long-term endpoints, also for patients with low level of education and patients on welfare benefits, cannot be ascribed to single elements of complex interventions. Patients with low level of education and income are frequently reported to be inadequately controlled with hyperglycaemia, hypertension, dyslipidaemia and unhealthy lifestyle [ 14 , 15 ], and some studies also suggest socio-demographic differences in prescription rates [ 16 , 20 ]. Our results are in line with earlier studies, concerning socio-demographic differences of intensive multifactorial interventions, which have been shown not to worsen or introduce social inequity in the control of T2DM [ 13 , 21 , 33 ].…”

“…Prior studies suggest that interventions seem to be effective, also among patient with low SES, in improving cardiovascular risk factors and prescription of medicine, but it is more difficult to assist patients in changing lifestyle and attitudes towards DM [ 13 , 21 , 33 , 34 ]. As a high-risk group patients with low SES have potentially more to win [ 9 , 10 ], but they are also known to have poor compliance especially regarding lifestyle and attitudes towards DM [ 5 , 14 , 15 ]. The individualization of diabetes care in the DCGP trial with negotiation of treatment goals, taking patient resources in consideration may explain why this intervention seems to be effective across the spectrum of SES.…”

“…Social inequality in mortality and morbidity of patients with T2DM can only be partially explained by differences in the increased incidence of other comorbid disease [ 1 , 11 ]. SES has been reported to influence metabolic control [ 12 ], pharmacological treatment [ 13 ] and ability to change lifestyle according to the recommendations [ 14 , 15 ]. Inequality in access to and utilization of health care [ 16 , 17 ] could influence the course of T2DM [ 18 , 19 ].…”

Localized Scleroderma, Systemic Sclerosis and Cardiovascular Risk: A Danish Nationwide Cohort Study

“…No data on traditional cardiovascular risk factors, such as body mass index, diet and smoking, were included. Information on smoking is not available in the databases; however, we indirectly adjusted for smoking using socioeconomic status and via chronic obstructive pulmonary disease (30,31). Another limitation is that some patients with LS are followed by their private dermatologist or general practitioner, and our results cannot be generalized to these patients.…”