title: Type 2 diabetes care in North Karelia Finland: do area-level socio-economic factors affect processes and outcomes?
abstract: OBJECTIVE
  This research assessed the impact of area-level socio-economic factors on the prevalence and outcomes of type 2 diabetes in North Karelia, Finland.
  
  
  METHODS
  All type 2 diabetes patients (n=10,204) were analyzed from the regional electronic patient database during the years 2011 and 2012. The patient's individual laboratory data was used to assess whether hemoglobin A1c (HbA1c) was measured and whether the recommended level of HbA1c <7% (<53 mmol/l) was achieved. The variables describing socio-economic characteristics of postal code areas were retrieved from the database of Statistics Finland. Linear and logistic regression analyses were used to determine associations.
  
  
  RESULTS
  HbA1c had been measured in 83% of patients. Over 70% of those with HbA1c measured reached the recommended level of HbA1c. The worse the area-level socio-economic status, the more probably HbA1c was not measured. Achieving the recommended HbA1c level was associated with being female and having a better area-level socio-economic status. The age-adjusted prevalence of type 2 diabetes was not linearly dependent on the socio-economic circumstances of the postal code areas.
  
  
  CONCLUSIONS
  This study shows that socio-economic factors at the small area-level are associated with treatment outcomes. The information from the regional electronic patient database linked with area-level socio-economic information could be effectively utilized to improve diabetes care.
authors.affiliation: Department of Geographical and Historical Studies, University of Eastern Finland, Joensuu, Finland. Electronic address: maija.sikio@uef.fi.
authors.forename: Maija
authors.initials: M
authors.lastname: Sikiö
authors.affiliation: Department of Geographical and Historical Studies, University of Eastern Finland, Joensuu, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Tykkyläinen
authors.affiliation: Health Centre of Outokumpu, Outokumpu, Finland.
authors.forename: Hilkka
authors.initials: H
authors.lastname: Tirkkonen
authors.affiliation: Department of Internal Medicine, Hospital District of North Karelia, Joensuu, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Kekäläinen
authors.affiliation: Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Dunbar
authors.affiliation: Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Australia; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Hospital District of North Karelia, Joensuu, Finland; Department of Chronic Disease Prevention, National Institute for Health and Welfare (THL), Helsinki, Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: Laatikainen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D005387:Finland / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors
chemical_list: D006442:Glycated Hemoglobin
keywords: Area-level socio-economic status; Outcomes of care; Patient database; Quality of care; Type 2 diabetes