The care and course of diabetes: differences according to level of education.
OBJECTIVE
The objective of this study was to describe socioeconomic differences in the utilisation of health services among persons with diabetes and to link these differences with socioeconomic differences in the course of diabetes.


METHODS
A 2-year follow-up study (1991-1993) was done with data from a population-based survey in The Netherlands (city of Eindhoven and surroundings). Those reporting diabetes who also reported treatment with a diet, oral antidiabetics or insulin and who completed questionnaires in the years 1991 and 1993 (n = 173) were included in the analysis. Main outcome measures were: (1) the odds ratios according to level of education of utilisation of 11 types of service or medical checks in 1991, relevant for diabetes; and (2) odds ratios according to level of education of the difference between 1991 and 1993 in the prevalence of symptoms of diabetic complications.


RESULTS
Controlling for severity of diabetes, contact rates with the general practitioner were significantly (P < 0.05) higher among those with primary education, compared to those with an educational level of intermediate vocational training or higher. Rates of checks by a specialist, influenza vaccination and many other checks were statistically significantly lower among those with a low educational level, although the group with the lowest educational level did not always show the lowest rates. Of symptoms indicating diabetes complications, the prevalence of pain in the legs and visual impairments developed more unfavourably among those with primary education. The prevalence of all symptoms together developed more unfavourably among those with primary education. A direct contribution of uptake of checks and services to the differential course of diabetes by education could not be demonstrated.


CONCLUSIONS
People with diabetes with a low level of education have lower utilisation rates of checks and services relevant for diabetes care, and a worse outcome in terms of complications.
van der Meer
J B
JB
Erasmus University Rotterdam, Department of Public Health, The Netherlands.
Mackenbach
J P
JP
D000368:Aged; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy*; D018450:Disease Progression; D004522:Educational Status; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006291:Health Policy; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000379:methods; D012935:Social Justice; D012959:Socioeconomic Factors; D013038:Specialization