Carl Willers1,2*, Hanna Iderberg2,3, Mette Axelsen4, Tobias Dahlstro ̈ m5, Bettina Julin2, Janeth Leksell6, Agneta Lindberg7, Peter Lindgren3,8, Karin Loostro ̈ m Muth9, Ann- Marie Svensson10, Mikael Lilja11
Socioeconomic status, origin or demographic attributes shall not determine the quality of healthcare delivery, according to e.g. United Nations and European Union rules. Health equity has been defined as the absence of systematic disparities and unwarranted differ- ences between groups defined by differences in social advantages. A study was performed to investigate whether this was applicable to type 1 diabetes mellitus (T1D) care in a setting with universal, tax-funded healthcare.
This retrospective registry-study was based on patient-level data from individuals diagnosed with T1D during 2010–2011 (n = 16,367) in any of seven Swedish county councils (covering ~65% of the Swedish population). Health equity in T1D care was analysed through multivari- ate regression analyses on absolute HbA1c level at one-year follow-up, one-year change in estimated glomerular filtration rate (eGFR) and one-year change in cardiovascular risk score, using selected sociodemographic dimensions as case-mix factors.
Higher educational level was consistently associated with lower levels of HbA1c, and so was being married. Never married was associated with worse eGFR development, and lower educational level was associated with higher cardiovascular risk. Women had higher HbA1c levels than men, and glucose control was significantly worse in patients below the age of 25.
Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus
Funding: Funding for this study was provided by Sveus, a research collaboration with seven Swedish regions developing systems for value- based monitoring and reimbursement of healthcare. Partial funding from Forte programme grant 2012/1688 ("Value and choice") is gratefully acknowledged.
Competing interests: CW, HI and BJ are employed by Ivbar Institute, a research company specialized in health care governance and analysis of health care data. The other authors state no disclosures.
HbA1c levels than men, and glucose control was significantly worse in patients below the age of 25.
Patients’ sociodemographic profile was strongly associated with absolute levels of risk fac- tor control in T1D, but also with an increased annual deterioration in eGFR. Whether these systematic differences stem from patient-related problems or healthcare organisational shortcomings is a matter for further research. The results, though, highlight the need for intensified diabetes management education and secondary prevention directed towards T1D patients, taking sociodemographic characteristics into account.
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