Poverty increases type 2 diabetes incidence and inequality of care despite universal health coverage.
OBJECTIVE
The discrepancy of diabetes incidence and care between socioeconomic statuses has seldom been studied concurrently in nations with universal health coverage. We aimed to delineate whether income disparity is associated with diabetes incidence and inequality of care under a national health insurance (NHI) program in Asia.


METHODS
From the Taiwan NHI database in 2000, a representative cohort aged ≥20 years and free of diabetes (n = 600,662) were followed up until 2005. We regarded individuals exempt from paying the NHI premium as being poor. Adjusted hazard ratios (HRs) were used to discover any excess risk of diabetes in the poor population. The indicators used to evaluate quality of diabetes care included the proportion of diabetic patients identified through hospitalization, visits to diabetes clinics, and completion of recommended diabetes tests.


RESULTS
The incidence of type 2 diabetes in the poor population was 20.4 per 1,000 person-years (HR, 1.5; 95% CI, 1.3-1.7). Compared with their middle-income counterparts, the adjusted odds ratio (OR) for the poor population incidentally identified as having diabetes through hospitalization was 2.2 (P < 0.001). Poor persons with diabetes were less likely to visit any diabetes clinic (OR, 0.4; P < 0.001). The ORs for the poor population with diabetes to receive tests for glycated hemoglobin, low-density lipoprotein cholesterol, triglycerides, and retinopathy were 0.6 (0.4-0.9), 0.4 (0.2-0.7), 0.5 (0.4-0.8), and 0.4 (0.2-0.9), respectively.


CONCLUSIONS
Poverty is associated not only with higher diabetes incidence but also with inequality of diabetes care in a northeast Asian population, despite universal health coverage.
Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan.
Chih-Cheng
CC
Hsu
Cheng-Hua
CH
Lee
Mark L
ML
Wahlqvist
Hsiao-Ling
HL
Huang
Hsing-Yi
HY
Chang
Likwang
L
Chen
Shu-Fang
SF
Shih
Shyi-Jang
SJ
Shin
Wen-Chen
WC
Tsai
Ted
T
Chen
Chi-Ting
CT
Huang
Jur-Shan
JS
Cheng
D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012959:Socioeconomic Factors; D013624:Taiwan; D019472:Universal Health Insurance