title: Impact of socio-economic position on health and quality of care in adults with Type 2 diabetes in France: the Entred 2007 study.
abstract: OBJECTIVE
  To describe the association between socio-economic position, health status and quality of diabetes care in people with Type 2 diabetes in France, where people may receive full healthcare coverage for chronic disease.
  
  
  METHODS
  Data from a national cross-sectional survey performed in people pharmacologically treated for diabetes were used. They combined data from medical claims, hospital discharge, questionnaires for patients (n = 3894 with Type 2 diabetes) and their physicians (n = 2485). Socio-economic position was assessed using educational level (low, intermediate, high) and ability to make ends meet (financial difficulties vs. financially comfortable).
  
  
  RESULTS
  People with diabetes reporting financial difficulties were more likely to be smokers (adjusted odds ratio 1.4; 95% CI 1.1-1.6) and obese (adjusted odds ratio 1.3; 95% CI 1.2-1.6) and to have poorer glycaemic control (HbA1c > 64 mmol/mol (8%); adjusted odds ratio 1.4; 95% CI 1.1-1.8), than those who were financially comfortable. They were more likely to have their diabetes diagnosed because of complications (adjusted odds ratio 1.6; 95% CI 1.3-2.0). They were also more likely to have coronary and podiatric complications (adjusted odds ratios 1.3; 95% CI 1.1-1.6 and 1.7; 95% CI 1.4-2.2, respectively). They benefited more often from full coverage (adjusted odds ratio 1.3; 95% CI 1.1-1.6), visited general practitioners more often (ratio of estimated marginal means 1.2; 95% CI 1.1-1.2) but specialists less often (adjusted odds ratio 0.7; 95% CI 0.6-0.8 for a visit to private ophthalmologist). They also felt less well informed about their condition.
  
  
  CONCLUSIONS
  Despite frequent access to full healthcare coverage, socio-economic position has an impact on the diagnosis of diabetes, health status and quality of diabetes care in France.
authors.affiliation: Department of Chronic Diseases and Injuries, French Institute for Public Health Surveillance, Saint-Maurice, France.
authors.forename: S
authors.initials: S
authors.lastname: Fosse-Edorh
authors.affiliation: Strategy and Research Department, National Health Insurance, Île-de-France, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Fagot-Campagna
authors.affiliation: Cemka-Eval, Bourg-la-Reine, France.
authors.forename: B
authors.initials: B
authors.lastname: Detournay
authors.affiliation: Department of Endocrinology, Diabetology and Metabolic Disease, Avicenne Hospital, Paris XIII University and Assistance Publique-Hôpitaux de Paris, Bobigny, France.
authors.forename: H
authors.initials: H
authors.lastname: Bihan
authors.affiliation: INSERM, Villejuif, France.
authors.forename: E
authors.initials: E
authors.lastname: Eschwege
authors.affiliation: National Institute for Prevention and Health Education, Saint-Denis, France.
authors.forename: A
authors.initials: A
authors.lastname: Gautier
authors.affiliation: Department of Chronic Diseases and Injuries, French Institute for Public Health Surveillance, Saint-Maurice, France.
authors.forename: C
authors.initials: C
authors.lastname: Druet
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003131:Combined Modality Therapy / Q000191:economics; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D048909:Diabetes Complications / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D058065:Diabetic Cardiomyopathies / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D017719:Diabetic Foot / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005602:France / Q000453:epidemiology; D017048:Health Care Costs; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D011787:Quality of Health Care; D012307:Risk Factors; D012959:Socioeconomic Factors