title: Inequalities in health care among patients with type 2 diabetes by individual socio-economic status (SES) and regional deprivation: a systematic literature review.
abstract: BACKGROUND
  Quality of care could be influenced by individual socio-economic status (SES) and by residential area deprivation. The objective is to synthesize the current evidence regarding inequalities in health care for patients with Type 2 diabetes mellitus (Type 2 DM).
  
  
  METHODS
  The systematic review focuses on inequalities concerning process (e.g. measurement of HbA1c, i.e. glycolised haemoglobin) and intermediate outcome indicators (e.g. HbA1c level) of Type 2 diabetes care. In total, of n = 886 publications screened, n = 21 met the inclusion criteria.
  
  
  RESULTS
  A wide variety of definitions for 'good quality diabetes care', regional deprivation and individual SES was observed. Despite differences in research approaches, there is a trend towards worse health care for patients with low SES, concerning both process of care and intermediate outcome indicators. Patients living in deprived areas less often achieve glycaemic control targets, tend to have higher blood pressure (BP) and worse lipid profile control.
  
  
  CONCLUSIONS
  The available evidence clearly points to the fact that socio-economic inequalities in diabetes care do exist. Low individual SES and residential area deprivation are often associated with worse process indicators and worse intermediate outcomes, resulting in higher risks of microvascular and macrovascular complications. These inequalities exist across different health care systems. Recommendations for further research are provided.
authors.forename: Olga
authors.initials: O
authors.lastname: Grintsova
authors.forename: Werner
authors.initials: W
authors.lastname: Maier
authors.affiliation: Helmholtz Zentrum Muenchen, Institute of Health Economics and Health Care Management, PO Box 1129, Neuherberg D-85758, Germany. mielck@helmholtz-muenchen.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mielck
mesh_terms: D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000628:therapy; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D008055:Lipids / Q000097:blood; D011787:Quality of Health Care / Q000191:economics*; D012111:Residence Characteristics; D012923:Social Class
chemical_list: D008055:Lipids