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Association between sociodemographic determinants and health outcomes in individuals with type 2 diabetes in Sweden
Ivbar Inst, Stockholm, Sweden.
Ivbar Inst, Stockholm, Sweden; Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.ORCID iD: 0000-0002-7616-9238
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
Karolinska Inst, Med Management Ctr, Stockholm, Sweden; Swedish Inst Hlth Econ, Lund, Sweden.
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2018 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 34, no 4, article id e2984Article in journal (Refereed) Published
Abstract [en]

Background: Concurrent multifactorial treatment is needed to reduce consequent risks of diabetes, yet most studies investigating the relationship between sociodemographic factors and health outcomes have focused on only one risk factor at a time. Swedish health care is mainly tax‐funded, thus providing an environment that should facilitate equal health outcomes in patients, independent of background, socioeconomic status, or health profile. This study aimed at investigating the association between several sociodemographic factors and diabetes‐related health outcomes represented by HbA1c, systolic blood pressure, low‐density lipoprotein cholesterol, predicted 5‐year risk of cardiovascular disease, and statin use.

Methods: This large retrospective registry study was based on patient‐level data from individuals diagnosed with type 2 diabetes during 2010 to 2011 (n = 416,228) in any of 7 Swedish regions (~65% of the Swedish population). Health equity in diabetes care analysed through multivariate regression analyses on intermediary outcomes (HbA1c, systolic blood pressure, and low‐density lipoprotein), predicted 5‐year risk of cardiovascular disease and process (i.e., statin use) after 1‐year follow‐up, adjusting for several sociodemographic factors.

Results: We observed differences in intermediary risk measures, predicted 5‐year risk of cardiovascular disease, and process dependent on place of birth, sex, age, education, and social setting, despite Sweden's articulated vision of equal health care.

Conclusions: Diabetes patients' health was associated with sociodemographic prerequisites. Furthermore, in addition to demographics (age and sex) and disease history, educational level, marital status, and region of birth are important factors to consider when benchmarking health outcomes, e.g., average HbA1c level, and evaluating the level of health equity between organizational units or between different administrative regions.

Place, publisher, year, edition, pages
2018. Vol. 34, no 4, article id e2984
Keywords [en]
type 2 diabetes mellitus, sociodemographics, HbA(1c), systolic blood pressure, statin use, cardiovascular disease
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:uu:diva-356510DOI: 10.1002/dmrr.2984ISI: 000431984700008PubMedID: 29377503OAI: oai:DiVA.org:uu-356510DiVA, id: diva2:1237938
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012/1688Available from: 2018-08-10 Created: 2018-08-10 Last updated: 2018-08-10Bibliographically approved

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Leksell, JanethDahlström, Tobias

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