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BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Socioeconomic inequalities in cardiometabolic control in patients with type 2 diabetes

Authors: Berta Ibáñez, Arkaitz Galbete, María José Goñi, Luis Forga, Laura Arnedo, Felipe Aizpuru, Julián Librero, Oscar Lecea, Koldo Cambra

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

The aim of this study was to determine if the achievement of control targets in patients with type 2 diabetes was associated with personal socioeconomic factors and if these associations were sex-dependent.

Methods

This cross-sectional, population-based study was conducted in Spain. Glycated haemoglobin (HbA1c) level and other clinical parameters were obtained from electronic primary care records (n = 32,638 cases). Socioeconomic status was determined using education level and yearly income. Among patients, having their HbA1c level checked during the previous year was considered as an indirect measure of the process of care, whereas tobacco use and clinical parameters such as HbA1c, low-density lipoprotein cholesterol (LDL-c) and blood pressure (BP) were considered intermediate control outcomes. General linear mixed effect models were used to assess associations.

Results

The achievement of metabolic and cardiovascular control targets in patients with type 2 diabetes was associated with educational level and income, and socioeconomic gradients differed by sex. The probability of having had an HbA1c test performed in the previous year was higher in patients with lower education levels. Patients in the lowest income and education level categories were less likely to have reached the recommended HbA1c level. Males in the lowest education level categories were less likely to be non-smokers or to have achieved the blood pressure targets. In contrast, patients within the low income categories had a higher probability of reaching the recommended LDL-c level.

Conclusions

Our results suggest the presence of socioeconomic inequalities in the achievement of cardiovascular and metabolic control that differed in direction and magnitude depending on the measured outcome and sex of the patient. These findings may help health professionals focus on high-risk individuals to decrease health inequalities.
Literature
1.
2.
Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22.CrossRef
3.
Wong ND, Zhao Y, Patel R, et al. Cardiovascular risk factor targets and cardiovascular disease event risk in diabetes: a pooling project of the atherosclerosis risk in communities study, multi-ethnic study of atherosclerosis, and Jackson heart study. Diabetes Care. 2016;39(5):668–76.CrossRefPubMedPubMedCentral
4.
American Diabetes Association. Standards of medical care in diabetes - 2016. Diabetes Care. 2016;39(S1):S39–80.
5.
Vinagre I, Mata-Cases M, Hermosilla E, et al. Control of glycaemia and cardiovascular risk factors in patients with type 2 diabetes in primary care in Catalonia (Spain). Diabetes Care. 2012;35:774–9.CrossRefPubMedPubMedCentral
6.
Chan JC, Gagliardino JJ, Baik SH, et al. Multifaceted determinants for achieving glycemic control the international diabetes management practice study (IDMPS). Diabetes Care. 2009;32(2):227–33.CrossRefPubMedPubMedCentral
7.
Seidu S, Walker NS, Bodicoat DH, Davies MJ, Khunti K. A systematic review of interventions targeting primary care or community based professionals on cardiometabolic risk factor control in people with diabetes. Diabetes Res Clin Pr. 2016;113:1–13.CrossRef
8.
Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol. 2011;40(3):804–18.CrossRefPubMed
9.
Espelt A, Borrell C, Roskam AJ, Rodriguez-Sanz M, Stirbu I, Dalmau-Bueno A, Artnik B. Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century. Diabetologia. 2008;51(11):1971–9.CrossRefPubMed
10.
Demakakos P, Marmot M, Steptoe A. Socioeconomic position and the incidence of type 2 diabetes: the ELSA study. Eur J Epidemiol. 2012;27(5):367–78.CrossRefPubMed
11.
Dalsgaard EM, Skriver MV, Sandbaek A, Vestergaard M. Socioeconomic position, type 2 diabetes and long-term risk of death. PLoS One. 2015;10(5):e0124829.CrossRefPubMedPubMedCentral
12.
Walker J, Halbesma N, Lone N, McAllister D, Weir CJ, Wild SH. Socioeconomic status, comorbidity and mortality in patients with type 2 diabetes mellitus in Scotland 2004–2011: a cohort study. J Epidemiol Community Health. 2016;70:596–601.CrossRefPubMed
13.
Saydah S, Imperatore G, Beckles GL. Socioeconomic status and mortality contribution of health care access and psychological distress among US adults with diagnosed diabetes. Diabetes Care. 2013;36(1):49–55.CrossRefPubMed
14.
Grintsova O, Maier W, Mielck A. Inequalities in health care among patients with type 2 diabetes by individual socio-economic status (SES) and regional deprivation: a systematic literature review. Int J Equity Health. 2014;13:43.CrossRefPubMedPubMedCentral
15.
Dalsgaard EM, Vestergaard M, Skriver MV, Borch-Johnsen K, Lauritzen T, Sandbaek A. Socioeconomic position and cardiovascular risk factors among people with screen-detected type 2 DM: six-year follow-up of the ADDITION-Denmark trial. Prim care diabetes. 2014;8(4):322–9.CrossRefPubMed
16.
O’Kane MJ, McMenamin M, Bunting BP, Moore A, Coates VE. The relationship between socioeconomic deprivation and metabolic/cardiovascular risk factors in a cohort of patients with type 2 diabetes mellitus. Prim care diabetes. 2010;4(4):241–9.CrossRefPubMed
17.
Wild S, Macleod F, McKnight J, Watt G, Mackenzie C, et al. Impact of deprivation on cardiovascular risk factors in people with diabetes: an observational study. Diabetic Med. 2008;25(2):194–9.CrossRefPubMed
18.
Tao X, Li J, Zhu X, Zhao B, Linong JS, et al. On behalf of CCMR-3B STUDY investigators. Association between socioeconomic status and metabolic control and diabetes complications: a cross-sectional nationwide study in Chinese adults with type 2 diabetes mellitus. Cardiovasc Diabetol. 2016;15:61.CrossRefPubMedPubMedCentral
19.
Walker RJ, Smalls BL, Egede LE. Social determinants of health in adults with type 2 diabetes—contribution of mutable and immutable factors. Diabetes Res Clin Pract. 2015;110(2):193–201.CrossRefPubMedPubMedCentral
20.
Chatterji P, Joo H, Lahiri K. Racial/ethnic-and education-related disparities in the control of risk factors for cardiovascular disease among individuals with diabetes. Diabetes Care. 2012;35(2):305–12.CrossRefPubMedPubMedCentral
21.
Brown AF, Ettner SL, Piette J, et al. Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiol Rev. 2004;26(1):63–77.CrossRefPubMed
22.
Walker RJ, Gebregziabher M, Martin-Harris B, Egede LE. Relationship between social determinants of health and processes and outcomes in adults with type 2 diabetes: validation of a conceptual framework. BMC Endocr Disord. 2014;14:82.CrossRefPubMedPubMedCentral
23.
Doorslaer EV, Koolman X. Explaining the differences in income-related health inequalities across European countries. Health Econ. 2004;13(7):609–28.CrossRefPubMed
24.
González B, Librero J, García-Sempere A, Peña L, Bauer S, Puig-Junoy J, Oliva J, Peiró S, Sanfélix-Gimeno G. Effect of cost sharing on adherence to evidence-based medications in patients with acute coronary syndrome. Heart. 2017;103(14):1082–1088.
25.
García-Gomez P, López A. Regional differences in socio-economic health inequalities in Spain. Working Papers, Research Center on Health and Economics 757, Department of Economics and Business, Universitat Pompeu Fabra, 2004.
26.
27.
López-González AA, Bennasar-Veny M, Tauler P, Aguilo A, Tomàs-Salvà M, Yáñez A. Desigualdades socioeconómicas y diferencias según sexo y edad en los factores de riesgo cardiovascular. Gac Sanit. 2015;29(1):27–36.CrossRefPubMed
28.
29.
Cambra K, Galbete A, Forga L, Lecea O, Ariz MJ, Moreno-Iribas C, Aizpuru F, Ibañez B. Sex and age differences in the achievement of control targets in patients with type 2 diabetes: results from a population-based study in a south European region. BMC Fam Pract. 2016;17:144.CrossRefPubMedPubMedCentral
30.
Larranaga I, Arteagoitia JM, Rodriguez JL, Gonzalez F, Esnaola S, Pinies JA. Socio-economic inequalities in the prevalence of type 2 diabetes, cardiovascular risk factors and chronic diabetic complications in the Basque Country. Spain Diabetic Med. 2005;22(8):1047–53.CrossRefPubMed
31.
Gnavi R, Picariello R, Karaghiosoff L, Costa G, Giorda C. Determinants of quality in diabetes care process: the population based Torino study. Diabetes Care. 2009;32(11):1986–91.CrossRefPubMedPubMedCentral
32.
Chen PC, Tsai CY, Woung LC, Lee YC. Socioeconomic disparities in preventable hospitalization among adults with diabetes in Taiwan: a multilevel modelling approach. Int J Equity Health. 2015;14:31.CrossRefPubMedPubMedCentral
33.
Regidor E, Martínez D, Calle ME, Astasio P, Ortega P. Domínguez V. Socioeconomic patterns in the use of public and private health services and equity in health care. BMC Health Serv Res. 2008;8(1):183.CrossRefPubMedPubMedCentral
34.
Palència L, Espelt A, Rodríguez-Sanz M, Rocha KB, Pasarín MI, Borrell C. Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993–2006. Eur J Health Econ. 2013;14(2):211–9.CrossRefPubMed
35.
Sundquist K, Chaikiat A, León VR, Johansson SE, Sundquist J. Country of birth, socioeconomic factors, and risk factor control in patients with type 2 diabetes: a Swedish study from 25 primary health-care centres. Diabetes Metab Res Rev. 2011;27(3):244–54.CrossRefPubMed
36.
Kautzky-Willer A, Harreiter J, Pacini G. Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocr Rev. 2016;37(3):278–316.CrossRefPubMedPubMedCentral
37.
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. Brit Med J. 2004;329(7477):1267–9.CrossRefPubMedPubMedCentral
38.
Collier A, Ghosh S, Hair M, Waugh N. Impact of socioeconomic status and gender on glycemic control, cardiovascular risk factors and diabetes complications in type 1 and 2 diabetes: a population based analysis from a Scottish region. Diabetes Metab. 2015;41(2):145–51.CrossRefPubMed
39.
Hiscock R, Bauld L, Amos A, Fidler JA, Munafò M. Socioeconomic status and smoking: a review. Ann N Y Acad Sci. 2012;1248(1):107–23.CrossRefPubMed
40.
Pinilla J, Abásolo I. The effect of policies regulating tobacco consumption on smoking initiation and cessation in Spain: is it equal across socioeconomic groups? Tob Induc Dis. 2017;15(1):8.CrossRefPubMedPubMedCentral
41.
Doshi T, Smalls BL, Williams JS, Wolfman TE, Egede LE. Objective and subjective measures of socioeconomic status and cardiovascular risk control in adults with diabetes. Am J Med Sci. 2016;352(1):36–44.CrossRefPubMedPubMedCentral
42.
González CA, Argilaga S, Agudo A, Amiano P, Barricarte A, Beguiristain JM, et al. Sociodemographic differences in adherence to the Mediterranean dietary pattern in Spanish populations. Gac Sanit. 2002;16(3):214–21.CrossRefPubMed
43.
Schröder H, Rohlfs I, Schmelz EM, Marrugat J, REGICOR investigators. Relationship of socioeconomic status with cardiovascular risk factors and lifestyle in a Mediterranean population. European j of nutr. 2004;43(2):77–85.CrossRef
44.
Hempler NF, Joensen LE, Willaing I. Relationship between social network, social support and health behaviour in people with type 1 and type 2 diabetes: cross-sectional studies. BMC Public Health. 2016;16:198.CrossRefPubMedPubMedCentral
45.
Houle J, Lauzier-Jobin F, Beaulieu MD, Meunier S, Coulombe, Côté J, Lespérance F, Chiasson JL, Bherer L. Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis. BMJ Open Diabetes Res Care. 2016;4(1):e000184.CrossRefPubMedPubMedCentral
46.
Walker RJ, Gebregziabher M, Martin-Harris B, Egede LE. Quantifying direct effects of social determinants of health on glycemic control in adults with type 2 diabetes. Diabetes Technol Ther. 2015;17(2):80–7.CrossRefPubMedPubMedCentral
47.
Katz LL, Anderson BJ, McKay SV, Izquierdo R, Casey TL, Higgins LA, HIrst K, Nadeau KJ, TODAY Study Group. Correlates of medication adherence in the TODAY cohort of youth with type 2 diabetes. Diabetes Care. 2016;39(11):1956–1962.
48.
Elissen AM, Hertroijs DF, Schaper NC, Bosma H, Dagnelie PC, Henry RM, et al. Differences in biopsychosocial profiles of diabetes patients by level of glycaemic control and health-related quality of life: the Maastricht study. PLoS One. 2017;12(7):e0182053.CrossRefPubMedPubMedCentral
49.
Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. 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). Diabetes Care. 2013;36(2):490.CrossRefPubMedCentral
Metadata
Title
Socioeconomic inequalities in cardiometabolic control in patients with type 2 diabetes
Authors
Berta Ibáñez
Arkaitz Galbete
María José Goñi
Luis Forga
Laura Arnedo
Felipe Aizpuru
Julián Librero
Oscar Lecea
Koldo Cambra
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5269-0

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