Prevalence of treated diabetes: Geographical variations at the small-area level and their association with area-level characteristics. A multilevel analysis in Southeastern France.
OBJECTIVE
This study estimated geographical variations in the prevalence of treated diabetes (TD) at the small-area level in Southeastern France to determine whether or not the characteristics of these areas (in particular, socioeconomic status or "SES") are associated with TD independent of person-level factors.


METHODS
The study used drug reimbursement data for 2008 from the General Health Insurance Scheme in Southeastern France for beneficiaries aged 18 years or over. TD patients were defined as those to whom oral antidiabetic drugs or insulin had been dispensed at least three times within the year. Area (canton) characteristics associated with the prevalence of TD were studied using multilevel Poisson regression.


RESULTS
In 2008, the crude prevalence of TD in adults in Southeastern France was 5.14%. In addition, TD prevalence was significantly higher in the more deprived and population-dense cantons independent of person-level factors (age, gender, low SES).


CONCLUSIONS
This study found a positive association between area deprivation and TD, and adds further evidence to the scanty data so far available on this topic. This finding should contribute to pinpointing priority action areas for programmes of diabetes prevention. However, more research is needed to further elucidate the mechanism(s) linking area deprivation and diabetes.
Bocquier
A
A
ORS PACA, Southeastern Health Regional Observatory, Marseille, France. aurelie.bocquier@inserm.fr
Cortaredona
S
S
Nauleau
S
S
Jardin
M
M
Verger
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D005843:Geography; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D016012:Poisson Distribution; D015995:Prevalence; D012959:Socioeconomic Factors; D055815:Young Adult
D007004:Hypoglycemic Agents; D007328:Insulin