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Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study
Ivbar Inst, Stockholm, Sweden;Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.
Karolinska Inst, Med Management Ctr, Stockholm, Sweden;Ivbar Inst, Stockholm, Sweden.
Univ Gothenburg, Dept Internal Med, Inst Med, Gothenburg, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 6, article id e0199170Article in journal (Refereed) Published
Abstract [en]

Background 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 differences 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. Methods 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 multivariate 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. Results 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. Conclusion Patients' sociodemographic profile was strongly associated with absolute levels of risk factor control in T1 D, 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.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE , 2018. Vol. 13, no 6, article id e0199170
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Endocrinology and Diabetes Public Health, Global Health, Social Medicine and Epidemiology
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URN: urn:nbn:se:uu:diva-360444DOI: 10.1371/journal.pone.0199170ISI: 000436793500006PubMedID: 29958293OAI: oai:DiVA.org:uu-360444DiVA, id: diva2:1247955
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012/1688Available from: 2018-09-13 Created: 2018-09-13 Last updated: 2018-09-13Bibliographically approved

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Dahlström, TobiasLeksell, Janeth

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