title: Social environment, morbidity and use of health care among people with diabetes mellitus in Trinidad.
abstract: BACKGROUND
  This study aimed to identify social characteristics associated with higher levels of morbidity from diabetes and their relationship to health care utilization.
  
  
  METHODS
  During a 6-month period 1149/1447 (79%) subjects admitted to Port of Spain Hospital, Trinidad with diabetes responded to a structured interview. Data collection included social factors, diabetes-related morbidity and health care utilization. Analyses were adjusted for age, sex, ethnic group and self-reported diabetes duration.
  
  
  RESULTS
  Of 12 indicators of morbidity, nine were more frequent in subjects with no schooling compared with those with secondary education. At ages 15-59 years, nine morbidity indicators were less frequent among subjects in full-time jobs compared with those not in employment. The association of educational attainment was explained by confounding with age, sex, ethnic group and diabetes duration but five morbidity indicators were associated with employment status after adjusting for confounding. The type of water supply in the home was generally not associated with morbidity. Each of the indicators of lower socioeconomic status was associated with less use of private doctors and with more use of government health centres.
  
  
  CONCLUSIONS
  Morbidity from diabetes was greater in groups with lower socioeconomic status. While morbidity associated with lower educational attainment was mostly explained by older age; the results suggested the possibility that diabetes may contribute to unemployment of those in the labour force. Private care was less accessible to social groups with higher levels of morbidity and the availability of government funded health services was important for reducing inequalities in health care utilization.
authors.affiliation: Commonwealth Caribbean Medical Research Council, Port of Spain, Trinidad and Tobago.
authors.forename: M C
authors.initials: MC
authors.lastname: Gulliford
authors.forename: S M
authors.initials: SM
authors.lastname: Ariyanayagam-Baksh
authors.forename: L
authors.initials: L
authors.lastname: Bickram
authors.forename: D
authors.initials: D
authors.lastname: Picou
authors.forename: D
authors.initials: D
authors.lastname: Mahabir
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D000368:Aged; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000208:ethnology; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016017:Odds Ratio; D012923:Social Class; D014300:Trinidad and Tobago / Q000453:epidemiology; D014881:Water Supply