Association among individual deprivation, glycemic control, and diabetes complications: the EPICES score.
OBJECTIVE
Previous studies have related poor glycemic control and/or some diabetes complications to low socioeconomic status. Some aspects of socioeconomic status have not been assessed in these studies. In the present study, we used an individual index of deprivation, the Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé (Evaluation of Precarity and Inequalities in Health Examination Centers [EPICES]) score, to determine the relationship among glycemic control, diabetes complications, and individual conditions of deprivation.


METHODS
We conducted a cross-sectional prevalence study in 135 consecutive diabetic patients (age 59.41 +/- 13.2 years [mean +/- SD]) admitted in the hospitalization unit of a French endocrine department. Individual deprivation was assessed by the EPICES score, calculated from 11 socioeconomic questions. Glycemic control, lipid levels, blood pressure, retinopathy, neuropathy, and nephropathy were assessed.


RESULTS
HbA(1c) level was significantly correlated with the EPICES score (r = 0.366, P < 0.001). The more deprived patients were more likely than the less deprived patients to have poor glycemic control (beta = 1.984 [SE 0.477], P < 0.001), neuropathy (odds ratio 2.39 [95% CI 1.05-5.43], P = 0.037), retinopathy (3.66 [1.39-9.64], P = 0.009), and being less often admitted for 1-day hospitalization (0.32 [0.14-0.74], P = 0.008). No significant relationship was observed with either nephropathy or cardiovascular risk factors.


CONCLUSIONS
Deprivation status is associated with poor metabolic control and more frequent microvascular complications, i.e., retinopathy and neuropathy. The medical and economic burden of deprived patients is high.
Bihan
Hélène
H
Université Paris XIII (CRNH) et Services de Médicine Interne et d'Endocrinologie, Hôpital Avicenne, 93009 Bobigny Cedex, France.
Laurent
Silvana
S
Sass
Catherine
C
Nguyen
Gérard
G
Huot
Caroline
C
Moulin
Jean Jacques
JJ
Guegen
René
R
Le Toumelin
Philippe
P
Le Clésiau
Hervé
H
La Rosa
Emilio
E
Reach
Gérard
G
Cohen
Régis
R
D001786:Blood Glucose; D001794:Blood Pressure; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000453:epidemiology*; D003929:Diabetic Neuropathies / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000453:epidemiology*; D005602:France / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006748:Hospital Departments; D006779:Hospitals, Public; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D006442:Glycated Hemoglobin