Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study.
OBJECTIVE
To investigate socio-economic inequalities in diabetes complications, and to examine factors that may explain these differences.


METHODS
Cross-sectional questionnaire survey of 770 individuals with diabetes among 40 general practices in Avon and Somerset. General practice, optometrist and eye hospital records over time (median 7 years) were analysed. Slope indices of inequality, odds ratios and incidence rate ratios were calculated to estimate the magnitude of inequality between the most and least educated, and the highest and lowest earning patients, adjusted for age, sex and type of diabetes, and clustering of outcomes within practices.


RESULTS
The least educated patients were more likely than the most educated patients to have diabetic retinopathy [adjusted odds ratio (OR) 4.3; 95% confidence interval 0.8, 23.7] and heart disease (adjusted OR 3.6; 1.1, 11.8), had higher HbA1c levels (adjusted slope index of inequality 0.9; 0.3, 1.5), felt that diabetes more adversely affected their social and personal lives (adjusted slope index of inequality 0.8; 0.5, 1.1 Diabetes Care Profile units), were more likely to be recorded as non-compliant by their health professionals, and had lower rates of hospital attendance (adjusted rate ratio 0.43; 0.26, 0.71). However, they did not see themselves as less compliant, and had higher general practice attendance rates (adjusted rate ratio 1.5; 1.1, 2.2).


CONCLUSIONS
Less educated and lower earning individuals with diabetes bear a larger burden of morbidity but use hospital care less. Health service resource allocation should reflect the distribution of chronic illness.
Bachmann
M O
MO
Medical Research Council Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol, UK. m.bachmann@uea.ac.uk
Eachus
J
J
Hopper
C D
CD
Davey Smith
G
G
Propper
C
C
Pearson
N J
NJ
Williams
S
S
Tallon
D
D
Frankel
S
S
D000368:Aged; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000453:epidemiology; D004493:Education; D004739:England / Q000453:epidemiology; D005194:Family Practice; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D006441:Hemoglobin A / Q000032:analysis; D006801:Humans; D007182:Income; D008297:Male; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D011610:Psychosocial Deprivation; D012648:Self Care; D012737:Sex Factors; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
D006441:Hemoglobin A