Inequalities in health care among patients with type 2 diabetes by individual socio-economic status (SES) and regional deprivation: a systematic literature review

International Journal for Equity in Health

Andreas Mielck¹  Werner Maier¹  Olga Grintsova¹ 

[1] Helmholtz Zentrum Muenchen, Institute of Health Economics and Health Care Management, PO Box 1129, Neuherberg D-85758, Germany

关键词: Review;    Regional deprivation;    Socio-economic status;    Health care;    Type 2 diabetes mellitus;   

Others  :  802236
DOI  :  10.1186/1475-9276-13-43

 received in 2013-10-15, accepted in 2014-05-21,  发布年份 2014

【 摘 要 】

Introduction

Quality of care could be influenced by individual socio-economic status (SES) and by residential area deprivation. The objective is to synthesize the current evidence regarding inequalities in health care for patients with Type 2 diabetes mellitus (Type 2 DM).

Methods

The systematic review focuses on inequalities concerning process (e.g. measurement of HbA1c, i.e. glycolised haemoglobin) and intermediate outcome indicators (e.g. HbA1c level) of Type 2 diabetes care. In total, of n = 886 publications screened, n = 21 met the inclusion criteria.

Results

A wide variety of definitions for ‘good quality diabetes care’, regional deprivation and individual SES was observed. Despite differences in research approaches, there is a trend towards worse health care for patients with low SES, concerning both process of care and intermediate outcome indicators. Patients living in deprived areas less often achieve glycaemic control targets, tend to have higher blood pressure (BP) and worse lipid profile control.

Conclusion

The available evidence clearly points to the fact that socio-economic inequalities in diabetes care do exist. Low individual SES and residential area deprivation are often associated with worse process indicators and worse intermediate outcomes, resulting in higher risks of microvascular and macrovascular complications. These inequalities exist across different health care systems. Recommendations for further research are provided.

【 授权许可】

   
2014 Grintsova et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Alwan DA: Global Status Report on Noncommunicable Diseases 2010. Geneva: World Health Organization; 2011.
• [2]World Health Organization: Diabetes: cost of diabetes. Volume Fact sheet #236. Geneva, Switzerland: WHO; 2010. http://www.who.int/mediacentre/factsheets/fs236/en/ webcite
• [3]UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998, 352:837-853.
• [4]Brown AF, Ettner SL, Piette J, Weinberger M, Gregg E, Shapiro MF, Karter AJ, Safford M, Waitzfelder B, Prata PA, Beckles GL: Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiologil Rev 2004, 26:63-77.
• [5]Whiting D: Diabetes: Equity and Social Determinants. Equity, Social Determinants and Public Health Programmes. Geneva, Switzerland: WHO Press, World Health Organization; 2010:77-94.
• [6]Connolly V, Unwin N, Sherriff P, Bilous R, Kelly W: Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas. J Epidemiol Community Health 2000, 54:173-177.
• [7]Espelt A, Arriola L, Borrell C, Larranaga I, Sandin M, Escolar-Pujolar A: Socioeconomic position and type 2 diabetes mellitus in Europe 1999–2009: a panorama of inequalities. Curr Diabetes Rev 2011, 7:148-158.
• [8]Robbins JM, Vaccarino V, Zhang H, Kasl SV: Socioeconomic status and diagnosed diabetes incidence. Diabetes Res Clin Pract 2005, 68:230-236.
• [9]Gnavi R, Karaghiosoff L, Costa G, Merletti F, Bruno G: Socio-economic differences in the prevalence of diabetes in Italy: the population-based Turin study. Nutr Metab Cardiovasc Dis 2008, 18:678-682.
• [10]Maier W, Holle R, Hunger M, Peters A, Meisinger C, Greiser KH, Kluttig A, Völzke H, Schipf S, Moebus S, Bokhof B, Berger K, Mueller G, Rathmann W, Tamayo T, Mielck A: The impact of regional deprivation and individual socio-economic status on the prevalence of Type 2 diabetes in Germany. A pooled analysis of five population-based studies. Diabet Med 2013, 30:e78-e86.
• [11]Ricci-Cabello I, Ruiz-Perez I, Olry de Labry-Lima A, Marquez-Calderon S: Do social inequalities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes? A systematic review. Health Soc Care Community 2010, 18:572-587.
• [12]Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR: Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2012, 55:1577-1596.
• [13]American Diabetes Association: Standards of medical care in diabetes. Diabetes Care 2005, 28:S4-S36.
• [14]Force ICGT: Global Guideline for Type 2 Diabetes. International Diabetes Federation: Brussels; 2005.
• [15]Moher D, Liberati A, Tetzlaff J, Altman DG, Group P: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009, 6:e1000097.
• [16]O’Connor PJ, Bodkin NL, Fradkin J, Glasgow RE, Greenfield S, Gregg E, Kerr EA, Pawlson LG, Selby JV, Sutherland JE, Taylor ML, Wysham CH: Diabetes performance measures: current status and future directions. Diabetes Care 2011, 34:1651-1659.
• [17]Aveyard H: Doing a Literature Review in Health and Social Care. 2nd edition. London: McGraw Hill Open University Press; 2010.
• [18]Thomas BH, Ciliska D, Dobbins M, Micucci S: A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evid Based Nurs 2004, 1:176-184.
• [19]Arday DR, Fleming BB, Keller DK, Pendergrass PW, Vaughn RJ, Turpin JM, Nicewander DA: Variation in diabetes care among states: do patient characteristics matter? Diabetes Care 2002, 25:2230-2237.
• [20]Bachmann MO, Eachus J, Hopper CD, Davey Smith G, Propper C, Pearson NJ, Williams S, Tallon D, Frankel S: Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study. Diabet Med 2003, 20:921-929.
• [21]Baz L, Muller N, Beluchin E, Kloos C, Lehmann T, Wolf G, Müller UA: Differences in the quality of diabetes care caused by social inequalities disappear after treatment and education in a tertiary care centre. Diabet Med 2012, 29:640-645.
• [22]Bebb C, Kendrick D, Stewart J, Coupland C, Madeley R, Brown K, Burden R, Sturrock N: Inequalities in glycaemic control in patients with Type 2 diabetes in primary care. Diabet Med 2005, 22:1364-1371.
• [23]Bihan H, Laurent S, Sass C, Nguyen G, Huot C, Moulin JJ, Guegen R, Le Toumelin P, Le Clésiau H, La Rosa E, Reach G, Cohen R: Association among individual deprivation, glycemic control, and diabetes complications: the EPICES score. Diabetes Care 2005, 28:2680-2685.
• [24]Bottle A, Millett C, Xie Y, Saxena S, Wachter RM, Majeed A: Quality of primary care and hospital admissions for diabetes mellitus in England. J Ambul Care Manage 2008, 31:226-238.
• [25]Brown AF, Gregg EW, Stevens MR, Karter AJ, Weinberger M, Safford MM, Gary TL, Caputo DA, Waitzfelder B, Kim C, Beckles GL: Race, ethnicity, socioeconomic position, and quality of care for adults with diabetes enrolled in managed care: the Translating Research into Action for Diabetes (TRIAD) study. Diabetes Care 2005, 28:2864-2870.
• [26]Geraghty EM, Balsbaugh T, Nuovo J, Tandon S: Using Geographic Information Systems (GIS) to assess outcome disparities in patients with type 2 diabetes and hyperlipidemia. J Am Board Fam Med 2010, 23:88-96.
• [27]Gnavi R, Picariello R, la Karaghiosoff L, Costa G, Giorda C: Determinants of quality in diabetes care process: the population-based Torino Study. Diabetes Care 2009, 32:1986-1992.
• [28]Gray J, Millett C, O’Sullivan C, Omar RZ, Majeed A: Association of age, sex and deprivation with quality indicators for diabetes: population-based cross sectional survey in primary care. J R Soc Med 2006, 99:576-581.
• [29]Guthrie B, Emslie-Smith A, Morris AD: Which people with Type 2 diabetes achieve good control of intermediate outcomes? Population database study in a UK region. Diabet Med 2009, 26:1269-1276.
• [30]Hippisley-Cox J, O’Hanlon S, Coupland C: Association of deprivation, ethnicity, and sex with quality indicators for diabetes: population based survey of 53,000 patients in primary care. Br Med J 2004, 329:1267-1269.
• [31]Hsu CC, Lee CH, Wahlqvist ML, Huang HL, Chang HY, Chen L, Shih SF, Shin SJ, Tsai WC, Chen T, Huang CT, Cheng JS: Poverty increases type 2 diabetes incidence and inequality of care despite universal health coverage. Diabetes Care 2012, 35:2286-2292.
• [32]Icks A, Rathmann W, Haastert B, Mielck A, Holle R, Lowel H, Giani G, Meisinger C: Quality of care and extent of complications in a population-based sample of patients with type 2 diabetes mellitus. The KORA Survey 2000. Dtsch Med Wochenschr 2006, 131:73-78.
• [33]James GD, Baker P, Badrick E, Mathur R, Hull S, Robson J: Ethnic and social disparity in glycaemic control in type 2 diabetes; cohort study in general practice 2004–9. J R Soc Med 2012, 105:300-308.
• [34]Larranaga I, Arteagoitia JM, Rodriguez JL, Gonzalez F, Esnaola S, Pinies JA, Sentinel Practice Network of the Basque Country: Socio-economic inequalities in the prevalence of Type 2 diabetes, cardiovascular risk factors and chronic diabetic complications in the Basque Country, Spain. Diabet Med 2005, 22:1047-1053.
• [35]Millett C, Car J, Eldred D, Khunti K, Mainous AG 3rd, Majeed A: Diabetes prevalence, process of care and outcomes in relation to practice size, caseload and deprivation: national cross-sectional study in primary care. J R Soc Med 2007, 100:275-283.
• [36]Reisig V, Reitmeir P, Doring A, Rathmann W, Mielck A, Group KS: Social inequalities and outcomes in type 2 diabetes in the German region of Augsburg. A cross-sectional survey. Int J Public Health 2007, 52:158-165.
• [37]Shani M, Nakar S, Lustman A, Baievsky T, Rosenberg R, Vinker S: Patient characteristics correlated with quality indicator outcomes in diabetes care. Br J Gen Pract 2010, 60:655-659.
• [38]Wilf-Miron R, Peled R, Yaari E, Shem-Tov O, Weinner VA, Porath A, Kokia E: Disparities in diabetes care: role of the patient’s socio-demographic characteristics. BMC Public Health 2010, 10:729. BioMed Central Full Text
• [39]Wong KW, Ho SY, Chao DV: Quality of diabetes care in public primary care clinics in Hong Kong. Fam Pract 2012, 29:196-202.
• [40]Gagliardino JJ, Aschner P, Baik SH, Chan J, Chantelot JM, Ilkova H, Ramachandran A, IDMPS Investigators: Patients’ education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS). Diabetes Metab 2012, 38:128-134.
• [41]Brook RH, McGlynn EA, Shekelle PG: Defining and measuring quality of care: a perspective from US researchers. Int J Qual Health Care 2000, 12:281-295.
• [42]Yudkin JS, Eggleston EM: ‘Hard’, ‘soft’ and ‘surrogate’ endpoints in diabetes. J Epidemiol Community Health 2013, 67:295-297.
• [43]Sidorenkov G, Haaijer-Ruskamp FM, de Zeeuw D, Bilo H, Denig P: Review: relation between quality-of-care indicators for diabetes and patient outcomes: a systematic literature review. Med Care Res Rev 2011, 68:263-289.
• [44]Nicolucci A, Greenfield S, Mattke S: Selecting indicators for the quality of diabetes care at the health systems level in OECD countries. Int J Qual Health Care 2006, 18(Suppl 1):26-30.
• [45]Merlo J, Chaix B, Yang M, Lynch J, Rastam L: A brief conceptual tutorial on multilevel analysis in social epidemiology: interpreting neighbourhood differences and the effect of neighbourhood characteristics on individual health. J Epidemiol Community Health 2005, 59:1022-1028.
• [46]Arnold-Worner N, Holle R, Rathmann W, Mielck A: The importance of specialist treatment, treatment satisfaction and diabetes education for the compliance of subjects with type 2 diabetes - results from a population-based survey. Exp Clin Endocrinol Diabetes 2008, 116:123-128.
• [47]Mielck A, Reitmeir P, Rathmann W: Knowledge about diabetes and participation in diabetes training courses: the need for improving health care for diabetes patients with low SES. Exp Clin Endocrinol Diabetes 2006, 114:240-248.
• [48]Stringhini S, Tabak AG, Akbaraly TN, Sabia S, Shipley MJ, Marmot MG, Brunner EJ, Batty GD, Bovet P, Kivimäki M: Contribution of modifiable risk factors to social inequalities in type 2 diabetes: prospective Whitehall II cohort study. Br Med J 2012, 345:e5452.