Social disadvantage: its impact on the use of Medicare services related to diabetes in NSW.
OBJECTIVE
To use Medicare data to examine the impact of social disadvantage on the use of health services related to diabetes.


METHODS
Information on number of diabetic individuals and number of services for select Medicare item codes were retrieved by New South Wales postcodes using a Health Insurance Commission data file. The postcodes were graded into quintiles of social disadvantage.


RESULTS
People at most social disadvantage were significantly less likely to be under the care of a general practitioner (adjusted OR 0.41; 95% CI 0.40-0.41) or consultant physician (adjusted OR 0.50; 95% CI 0.48-0.53), despite this group having the highest prevalence of diabetes. The difference in attendance to other specialists was less marked but nevertheless significant (adjusted OR 0.71; 95% CI 0.68-0.75). Once under a doctor's care, patients at most disadvantage were slightly more likely to undergo HbA1c or microalbuminuria estimation (adjusted OR 1.04; 95% CI 1.00-1.10 and adjusted OR 1.22; 95% CI 1.12-1.33, respectively) but were less likely to undergo lipid or HDL cholesterol estimation (adjusted OR 0.81; 95% CI 0.48-0.53 and adjusted OR 0.85; 95% CI 0.79-0.90, respectively).


CONCLUSIONS
While access to medical care is decreased for people at most social disadvantage, once under a doctor's care they receive a level of monitoring that is relatively equal to that provided to people less disadvantaged.


CONCLUSIONS
Strategies are required to ensure equal access to medical services for all persons with diabetes, especially for persons who are at most social and medical disadvantage.
The Department of Family and Community Nursing, The University of Sydney, New South Wales. joverland@nursing.usyd.edu.au
Jane
J
Overland
Lillian
L
Hayes
Dennis K
DK
Yue
D019963:Clinical Chemistry Tests; D003920:Diabetes Mellitus / Q000097:blood / Q000191:economics* / Q000208:ethnology* / Q000652:urine; D006296:Health Services / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D009313:National Health Programs / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D009517:New South Wales / Q000453:epidemiology; D012923:Social Class; D012935:Social Justice; D019472:Universal Health Insurance