Exploring equity in accessing diabetes management treatment: A healthcare gap analysis

Tapager, Ina; Olsen, Kim Rose; Vrangbæk, Karsten

doi:10.1016/j.socscimed.2021.114550

Cited by 13 publications

(13 citation statements)

References 35 publications

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“…In a similar vein, even though the present study did not focus on the effects of medical treatment on specific blood analytes (e.g., effects of diabetes medication on HbA1c), it is possible that the education differences estimated in the present study may be related to some extent to the differential utilisation of medical services and treatment options across educational attainment categories or other socioeconomic indicators, as suggested elsewhere [ 49 – 51 ]. Thus, the cardiometabolic risk differences may either increase or decrease depending on the extent to which medical treatment contributes to a relative reduction or relative increase in the cardiometabolic risk profile across educational attainment categories.…”

Section: Discussionmentioning

confidence: 74%

Education differences in cardiometabolic risk in England, Scotland and the United States between 1992 and 2019

Montaño

2022

BMC Cardiovasc Disord

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Background Education differences in cardiometabolic risk and disease still play a major role in the magnitude of the socioeconomic health disparities in high-income societies. However, the knowledge on how education differences may have changed over time regarding the distribution of multiple risk factors is rather limited. This study aims to provide a comprehensive assessment of the magnitude of those differences in three high-income countries. Methods Data from repeated cross-sectional population health and examination surveys conducted between 1992 and 2019 in England, Scotland and the United States are analysed (pooled sample size $$n = 362{,}275$$ n = 362 , 275 ). Six cardiometabolic risk factors, namely, systolic and diastolic blood pressure, body-mass-index, glycated haemoglobin HbA1c, serum total cholesterol and the cardiovascular risk score are analysed with linear mixed models. Results Education differences in cardiometabolic risk were found to have either increased or remained stable for the past 3 decades in the countries included in the analyses. Among individuals with no qualification the cardiometabolic risk has been higher than among the higher educated (mean difference: 0.136, 99% CI [0.119; 0.152]). Education differences were observed also for systolic blood pressure (2.788 mmHg, 99% CI [2.529; 3.047]), glycated haemoglobin HbA1c (0.160 %, 99% CI [0.136; 0.185]), total cholesterol (0.268 mmol/L, 99% CI [0.247; 0.289]) and body-mass-index (0.591 kg/m2, 99% CI [0.504; 0.679]). Conclusion The results suggest a more complex pattern of associations between education and health which may be due to education-dependent processes related to behavioural, cognitive and attitudinal modification and adaptation to changing socio-cultural conditions.

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Section: Discussionmentioning

confidence: 74%

Education differences in cardiometabolic risk in England, Scotland and the United States between 1992 and 2019

Montaño

2022

BMC Cardiovasc Disord

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“…Table 1 shows respondent characteristics. By design ( Tapager et al, 2022b ), the majority of respondents were relatively newly diagnosed with T2D (self-reported diagnosis within the previous five years) and more than a third reported at least one heart, eye, kidney, nerve or foot condition. Most respondents were either employed or retired, including loss of fitness-for-work early retirement ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Previous analyses of baseline survey data suggest that respondents underrepresented socioeconomically disadvantaged populations, even though they did cover a range of sociodemographic groups ( Tapager et al, 2022b ). In addition, this study primarily included persons diagnosed within the last five years, and the findings may not apply to people with longer diabetes duration.…”

Section: Discussionmentioning

confidence: 99%

“…In October 2019, a survey was conducted among a random sample of people with T2D in Denmark investigating aspects of health, healthcare, well-being and capabilities with the primary aim of studying healthcare access, use and quality for persons with T2D and associations between healthcare characteristics and personal capabilities ( Tapager et al, 2022b ). Due to the emergence of the pandemic, the follow-up survey that was planned to take place a year later was adjusted to include additional questions about worries and problems related to the pandemic crisis thus enabling the present analyses.…”

Section: Methodsmentioning

confidence: 99%

“…Survey data were merged with registry data and accessed and analysed through the Statistics Denmark research platform, providing secured access to pseudonymised registry and survey data. Baseline survey data collection is described in further detail elsewhere ( Tapager et al, 2022b ).…”

Section: Methodsmentioning

confidence: 99%

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The role of self-efficacy, well-being capability and diabetes care assessment for emotional and diabetes management challenges during the COVID-19 pandemic: Findings from a follow-up study

Tapager

Joensen²,

Vrangbæk³

2022

Social Science & Medicine

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Mortality risk for kidney transplant candidates with diabetes: a population cohort study

Rashid,

Chaudhry,

Evison

et al. 2024

Diabetologia

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Aims/hypothesis It is unclear whether kidney transplant candidates with diabetes have equitable transplantation opportunities or have divergent survival probabilities stratified by kidney replacement therapy. The aim of this study was to investigate these two issues using national transplant registry data in the UK. Methods A cohort study was undertaken of prospectively collected registry data of all wait-listed people with kidney failure receiving dialysis in the UK. All people listed for their first kidney-alone transplant between 2000 and 2019 were included. Stratification was done for cause of kidney failure. Primary outcome was all-cause mortality. Time-to-death from listing was analysed using adjusted non-proportional hazard Cox regression models, with transplantation handled as a time-dependent covariate. Results A total of 47,917 wait-listed people with kidney failure formed the total study cohort, of whom 6594 (13.8%) had diabetes classified as cause of kidney failure. People with kidney failure with diabetes comprised 27.6% of the cohort (n=3681/13,359) that did not proceed to transplantation vs only 8.4% (n=2913/34,558) of the cohort that received a transplant (p<0.001). Kidney transplant candidates with diabetes were more likely to be older, of male sex and of ethnic minority background compared with those without diabetes. In an adjusted analysis, compared with remaining on dialysis, any kidney transplant provided survival benefit for wait-listed kidney transplant candidates regardless of diabetes as cause of kidney failure (RR 0.26 [95% CI 0.25, 0.27], p<0.001). Conclusions/interpretation Kidney transplant candidates with diabetes have a lower chance of transplantation despite better survival after kidney transplantation vs remaining on dialysis. The reasons for this require further investigation to ensure equal transplantation opportunities. Graphical Abstract

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Exploring equity in accessing diabetes management treatment: A healthcare gap analysis

Cited by 13 publications

References 35 publications

Education differences in cardiometabolic risk in England, Scotland and the United States between 1992 and 2019

Education differences in cardiometabolic risk in England, Scotland and the United States between 1992 and 2019

The role of self-efficacy, well-being capability and diabetes care assessment for emotional and diabetes management challenges during the COVID-19 pandemic: Findings from a follow-up study

Mortality risk for kidney transplant candidates with diabetes: a population cohort study

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