Income-related differences in mortality among people with diabetes mellitus

Lipscombe, Lorraine L.; Austin, Peter C.; Dujovny, Manuel; Shah, Baiju R.; Hux, Janet E.; Booth, Gillian L.

doi:10.1503/cmaj.090495

Cited by 54 publications

(51 citation statements)

References 28 publications

(18 reference statements)

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“…No Canadá, a mortalidade de indiví-duos diabéticos no período 1994-2005 foi analisada com base em categorias de renda, sendo verificada redução estatisticamente significativa, no grupo da população que apresentava rendimento mais alto em comparação com aquele de menor renda (16). Nos Estados Unidos, foi observado que os progressos alcançados no cuidado do diabetes trouxeram maior benefício para os indivíduos com alta escolaridade (35).…”

Section: Discussionunclassified

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Tendência da mortalidade por diabetes melito em capitais brasileiras, 1980-2007

Mattos

Luz

Santiago

et al. 2012

Arq Bras Endocrinol Metab

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RESUMOObjetivo: Analisar o padrão de mortalidade por diabetes nas capitais brasileiras entre 1980 e 2007. Materiais e métodos: Foram calculadas taxas de mortalidade quadrienais e anuais, padronizadas por idade pela população mundial. Modelos de regressão linear foram estimados para análise da tendência nas capitais. Resultados: No primeiro quadriênio, a taxa mais elevada correspondeu a 42,89/100.000 em Aracaju e, no último, a 54,38/100.000 em São Luís. Foram observadas tendências estatisticamente significativas de incremento na maioria das capitais, embora com diferenças regionais. Belo Horizonte foi a única capital a mostrar tendência de declínio. Conclusões: Uma parte do incremento observado poderia ser atribuída a melhoras no acesso ao diagnóstico e na certificação da causa de morte, porém diferenças regionais na prevalência de fatores de risco e proteção para a doença possivelmente também estão implicadas. A não disponibilidade de série histórica de casos incidentes impossibilita determinar se esses resultados refletem tendências atuais da incidência do diabetes no Brasil. Arq Bras Endocrinol In the first quadrennial period, the highest rate was 42.89/100,000 in Aracaju; and in the last quadrennial period, 54.38/100,000 in São Luis. Although mortality rates showed statistically significant incremental trends in most capitals, there were regional differences. Belo Horizonte was the only capital to show a declining trend. Conclusions: Part of the observed increment could be attributed to improvements in access to diagnosis and death certification, but regional differences in the prevalence of diabetes risk and protective factors might also be implicated. The absence of a time series of incident cases makes it difficult to determine if these results reflect current trends in the incidence of diabetes in Brazil. InTRODUçãO O padrão epidemiológico do diabetes melito tipo 2 no mundo tem se modificado nas últimas déca-das e essas mudanças têm sido atribuídas a modificações nos hábitos alimentares, aumento da inatividade física e da obesidade, à urbanização e ao envelhecimento da população (1). Espera-se que, entre 2000 e 2030, sua prevalência global dobre, atingindo cerca de 366 mi-

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Section: Discussionunclassified

“…Indivíduos com diabetes apresentam maior risco de vida, principalmente, por alterações cardiovasculares circulatórias e renais (15,16). É, portanto, importante conhecer o padrão de distribuição da mortalidade por essa doença nas diferentes regiões do país.…”

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Tendência da mortalidade por diabetes melito em capitais brasileiras, 1980-2007

Mattos

Luz

Santiago

et al. 2012

Arq Bras Endocrinol Metab

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“…Examining data from participants in the third National Health and Nutrition Examination Survey (NHANES), Robbins et al [34] found that socioeconomic status, and particularly income level, was associated with excess diabetes prevalence. Subsequent studies have extended these findings to further demonstrate the excess prevalence [35] and note associations with increased complications [36,37] and mortality [38]. Seligman et al [26] also report on NHANES data when they conclude that participants with food insecurity are more likely to have diabetes (adjusted odds ratio [OR] 2.1, 95 % confidence interval [95 % CI] 1.1-4.0).…”

Section: Overview Of Materials Need Insecurities In Diabetesmentioning

confidence: 98%

Material Need Support Interventions for Diabetes Prevention and Control: a Systematic Review

et al. 2015

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Unmet material needs, such as food insecurity and housing instability, are associated with increased risk of diabetes and worse outcomes among diabetes patients. Healthcare delivery organizations are increasingly held accountable for health outcomes that may be related to these "social determinants," which are outside the scope of traditional medical intervention. This review summarizes the current literature regarding interventions that provide material support for income, food, housing, and other basic needs. In addition, we propose a conceptual model of the relationship between unmet needs and diabetes outcomes and provide recommendations for future interventional research.

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“…With or without adjustment for age, LDL-C goal achievement did not change in this study. Another Canadian study using a population-based administrative database found a di erence in mortality that was related to income-related di erences among people with diabetes [13]. e study reported an overall mortality decreased by more than 30% from 1994/95 to 2005/06; however, analysis by income quintile demonstrated that the improvement in mortality was signi cantly smaller among people in lower income neighbourhoods than among those in wealthier neighbourhoods.…”

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confidence: 95%

Household income and LDL-C goal attainment in patients with diabetes and dyslipidemia in a Canadian dataset

Farahani¹,

Levine²

2014

CIM

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Household income and LDL-C goal attainment in patients with diabetes and dyslipidemia in a Canadian dataset Abstract Purpose: ere is evidence of a social disparity pertaining to the epidemiology and burden of illness of diabetes.e purpose of this study was to assess the association between household income strata and therapeutic goal achievement rates for LDL-cholesterol (LDL-C) (< 2.5 mmol/L) in Canadian diabetic patients.Methods: Data (household income, cardiovascular risk factors, drug pro le, clinical and laboratory variables) were obtained from a previous cross-sectional study of diabetic patients who lled a prescription for a lipid-lowering drug in selected pharmacies across Canada. Telephone interviews were conducted. Physicians, identi ed by the participating patients, were requested to complete a short questionnaire for clinical data. Achievement of LDL-C goals according to the Canadian diabetes guidelines were assessed and incorporated into regression models corresponding to household income strata.Results: Seven household income strata were de ned in the cohort (from less than 20,000 CDN$, up to 70,000 CDN$ by increments of 10,000 CDN$). LDL-C goals were attained in 34% of patients in the total cohort. ere were no signi cant di erences amongst household income strata for LDL-C goal achievement (p = 0.80). ere were no signicant di erences in patient characteristics (age, sex, BMI) and cardiovascular risks according to the household income strata in this cohort, except age more than 65 in the lower income strata.Conclusion: is study demonstrates that household income was not a factor to achieve therapeutic goals for LDL-C for patients with diabetes in this dataset, although goal attainment was less than ideal overall. Future studies should address limitations of this work including small sample size, recruitment bias and lack of data on third party insurance coverage.

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Income-related differences in mortality among people with diabetes mellitus

Cited by 54 publications

References 28 publications

Tendência da mortalidade por diabetes melito em capitais brasileiras, 1980-2007

Tendência da mortalidade por diabetes melito em capitais brasileiras, 1980-2007

Material Need Support Interventions for Diabetes Prevention and Control: a Systematic Review

Household income and LDL-C goal attainment in patients with diabetes and dyslipidemia in a Canadian dataset

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