Impact of Deprivation on the Management of Diabetes in Primary Health Care
Al Zayadi, Amal
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Background: Socioeconomic factors and gender may influence the quality of care received by patients with diabetes. Millions of people are diagnosed with diabetes and rates are expected to increase. The management of diabetes in primary care is important in optimizing health for all. Objectives: To investigate whether the selected diabetes quality of care indicators (haemoglobin A1c, low-density lipoprotein, blood pressure, abumin to creatinine ratio (ACR), and prescribed medication) are significantly different between those persons living in least and most materially and socially deprived neighbourhoods. Methods: A cross-sectional study design with a population sample of patients with diabetes from a primary care practice in Southeast Ontario. De- identified patient data from electronic medical records were retrieved from the Canadian Primary Care Sentinel Surveillance Network. Combined material and social deprivation scores were based on the Pampalon Deprivation Index. Results: The patients with diabetes largely resided in either the most or the least deprived neighbourhoods. Patients with diabetes living in the most deprived neighbourhoods were less likely than patients with diabetes living in the least deprived neighbourhoods to have their low-density lipoproteins within normal range (RR=0.84; CIs 0.73-0.98; p-value=0.026). There was no difference in management of diabetes between least and most deprived patients with diabetes regarding haemoglobin A1c, blood pressure, ACR, and medication prescribed; these were positive result for the clinical practice. Women with diabetes were less likely than men with diabetes to have their low-density lipoproteins under control (RR=0.71; CIs 0.62-0.81; p-value <0.001) and be prescribed ACE inhibitors or ARBs (RR=0.79; CIs 0.69-0.90; p-value <0.001). However, women with diabetes were more likely to have their most recent haemoglobin A1c within normal range (RR=1.24; CIs 1.10-1.40; p-value <0.001) and have their most recent ACR within normal range (RR=1.25; CIs 1.05-1.50; p-value=0.015). Conclusion: This study found that the quality of care for patients with diabetes was not influenced by whether a person lived in a deprived neighbourhood or not. However, the study identified some important gender differences related to whether a person’s diabetes was under control. The reason for these differences is unknown.