title: Demographic and regional disparities in insulin pump utilization in a setting of universal funding: a New Zealand nationwide study.
abstract: OBJECTIVE
  Insulin pumps have been publically funded in New Zealand since 2012 for patients who meet certain clinical criteria; however, the patterns of utilization have not been described. We undertook a nationwide study to estimate the annual proportions of patients with type 1 diabetes mellitus who used a pump between 2012 and 2014, overall, and according to sex, age, ethnicity, socioeconomic position, and region.
  
  
  METHODS
  We used data from the New Zealand Virtual Diabetes Register and routinely collected national demographic, health, and pharmaceutical dispensing data from the Ministry of Health to identify patients with type 1 diabetes and to calculate the overall, and subgroup, proportions using pumps.
  
  
  RESULTS
  Between 2012 and 2014, funded pump use among patients with type 1 diabetes (n = 13,727) increased from 1.8 to 9.3 % overall; however, there were differences in uptake according to demographic characteristics and region. In 2014, proportionate pump use was significantly higher in females versus males (adjusted odds ratio (OR) 2.0 [95 % confidence interval 1.8-2.3]), in those aged <20 years, and in some regions. Māori (indigenous people), Pacific, and Asian patients were significantly less likely to use pumps than New Zealand Europeans (ORs 0.30 [0.23-0.41], 0.26 [0.14-0.46], 0.22 [0.14-0.35], respectively), as were those in the most versus the least deprived socioeconomic decile (OR 0.36 [0.25-0.52]).
  
  
  CONCLUSIONS
  It is essential to explore the factors driving differential insulin pump uptake, in both New Zealand and elsewhere, if all patients are to have equal opportunity to benefit from intensive diabetes management.
authors.affiliation: Dunedin School of Medicine, University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand.
authors.forename: Erin
authors.initials: E
authors.lastname: McKergow
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand. lianne.parkin@otago.ac.nz.
authors.forename: Lianne
authors.identifier: http://orcid.org/0000-0002-6824-6176
authors.initials: L
authors.lastname: Parkin
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand.
authors.forename: David J
authors.initials: DJ
authors.lastname: Barson
authors.affiliation: Department of Mathematics and Statistics, University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand.
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Sharples
authors.affiliation: Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Wheeler
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002648:Child; D002675:Child, Preschool; D003710:Demography; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000453:epidemiology*; D005006:Ethnicity; D005260:Female; D005843:Geography; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012042:Registries; D012737:Sex Factors; D012959:Socioeconomic Factors; D044465:White People; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Epidemiology; Ethnicity; Insulin pump; Socioeconomic position; Utilization