Exploring social inequalities in healthcare trajectories following diagnosis of diabetes: a state sequence analysis of linked survey and administrative data

Abstract

Background Social inequalities in complications associated with diabetes mellitus persist. As a primary care sensitive condition (PCSC), this association could be related to differential access to primary care. Our objectives are to establish a typology of care trajectories following a new diagnosis, and to explore social determinants of trajectories. Methods We used the TorSaDe (The Care Trajectories-Enriched Data) cohort, which links Canadian Community Health Survey respondents to health administrative data. Care trajectories were mapped over a two-year period following a new diagnosis and analysed using state sequence and clustering methods. Associations between individual and geographic characteristics with trajectory types were assessed with multinomial logistic regression. Results Three trajectories were identified: Regular Family Physician (FP) Predominant, Specialist Physician Predominant, and Few Services. With Regular FP as the reference, males had higher odds of experiencing the Few Services trajectory, higher education was associated with higher odds of both the Few Services and the Specialist trajectories, and immigrants had higher odds of the Specialist trajectory. Diagnoses in a physician’s office, as opposed to in hospital, were associated with higher odds of the Regular FP trajectory. Conclusions The Regular FP trajectory most closely aligns with the management principles of the PCSC approach. We did not find strong evidence of social status privileging access to this trajectory. However, the association with location of diagnosis suggests that efforts to ensure patients diagnosed in hospital are well linked to a regular family physician for follow up may help to reduce unnecessary specialist use and meet PCSC goals.

Ambulatory Healthcare Use Profiles of Patients With Diabetes and Their Association With Quality of Care: A Cross-Sectional Study

“…For instance, data-driven clustering of a heterogeneous patient population based on age and healthcare use allowed the identification of distinct patient profiles with differing subsequent healthcare utilization and mortality in Singapore ( 17 ). In the field of diabetes care, population segmentation methods are also increasingly used ( 18 , 19 ). Three profiles of diabetic patients with a distinct use of health services were identified in Dutch general practices using a data-driven segmentation approach ( 20 ).…”

Discovering patterns in outpatient neurology appointments using state sequence analysis

“…The same team also used SSA to study care trajectories preceding a diagnosis of schizophrenia [ 14 ]. Other recent studies using SSA in healthcare include an examination of social inequalities in care trajectories following a diagnosis of diabetes [ 15 ], and a study of referral trajectories in patients with vertigo [ 16 ].…”