Socio-economic disparities in hospital care among Dutch patients with diabetes mellitus.
Diabetes Obes Metab
; 26(4): 1386-1394, 2024 Apr.
Article
em En
| MEDLINE
| ID: mdl-38229451
ABSTRACT
AIM:
Socio-economic status (SES) influences diabetes onset, progression and treatment. In this study, the associations between SES and use of hospital care were assessed, focusing on hospitalizations, technology and cardiovascular complications. MATERIALS ANDMETHODS:
This was an observational cohort study comprising 196 695 patients with diabetes (all types and ages) treated in 65 hospitals across the Netherlands from 2019 to 2020 using reimbursement data. Patients were stratified in low, middle, or high SES based on residential areas derived from four-digit zip codes.RESULTS:
Children and adults with low SES were hospitalized more often than patients with middle or high SES (children 22%, 19% and 15%, respectively; p < .001, adults 28%, 25% and 23%; p < .001). Patients with low SES used the least technology no technology in 48% of children with low SES versus 40% with middle SES and 38% with high SES. In children, continuous subcutaneous insulin infusion (CSII) and real-time continuous glucose monitoring (rtCGM) use was higher in high SES {CSII odds ratio (OR) 1.54 [95% confidence interval (CI) 1.35-1.76]; p < .001; rtCGM OR 1.39 [95% CI 1.20-1.61]; p < .001} and middle SES [CSII OR 1.41 (95% CI 1.24-1.62); p < .001; rtCGM OR 1.27 (95% CI 1.09-1.47); p = .002] compared with low SES. Macrovascular (OR 0.78 (95% CI 0.75-0.80); p < .001) and microvascular complications [OR 0.95 (95% CI 0.93-0.98); p < .001] occurred less in high than in low SES.CONCLUSIONS:
Socio-economic disparities were observed in patients with diabetes treated in Dutch hospitals, where basic health care is covered. Patients with low SES were hospitalized more often, used less technology, and adults with high SES showed fewer cardiovascular complications. These inequities warrant attention to guarantee equal outcomes for all.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
2_ODS3
Base de dados:
MEDLINE
Assunto principal:
Diabetes Mellitus Tipo 1
/
Hipoglicemiantes
Tipo de estudo:
Health_economic_evaluation
/
Observational_studies
/
Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
/
Equity_inequality
Limite:
Adult
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Child
/
Humans
Idioma:
En
Revista:
Diabetes Obes Metab
Ano de publicação:
2024
Tipo de documento:
Article