Social inequalities in health status and care practices among patients admitted to hospital with diabetes mellitus in Trinidad - abstract

ABSTRACT

Of 1149/1447 (79 percent) patients admitted to the General Hospital, Port-of-Spain, with diabetes mellitus in a 6-month period, 138 (12 percent) had no schooling (NS), 782 (68 percent) had only primary education (PE), 119 (17 percent) had secondary education or higher (SE), 30 (3 percent) were not classified. Compared with patients with SE, those with NS were older, were more likely to be women, or of East Indian descent and to have effort chest pain, a history of `stroke' or `heart attack' (Odds Ratio (OR) 3.51 (95 percent CI 1.97 to 6.24)), neuropathic symptoms (OR 1.72 (1.11 to 2.68)) and vision defects (OR 2.97 (1.28 to 6.87)). Variations in the prevalence of these conditions were mostly explained by confounding with increasing age, female sex and East Indian ethnicity. Patients with NS were more likely to attend a health centre than a private doctor as their usual source of care (OR 4.51 (2.76 to 7.35)), were less likely to have attended a dietitian (OR 0.53 (0.34 to 0.83)), and were less likely to test for blood glucose at home (OR 0.14 (0.03 to 0.61)). Adjusting for age, gender and ethnic group did not explain social inequalities in the usual source of care, attendance at a dietitian or use of home blood glucose monitoring. Our data are consistent with the `inverse care law' those most affected by diabetic complications had more limited access to health care (AU)