Open AccessHealth Inequalities Among Elderly Type 2 Diabetes Mellitus Patients in Japan
Author(s) -
Peng Jiang,
Akira Babazono,
Takako Fujita
Publication year - 2020
Publication title -
population health management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 40
eISSN - 1942-7905
pISSN - 1942-7891
DOI - 10.1089/pop.2019.0141
Subject(s) - medicine , hazard ratio , diabetes mellitus , odds ratio , logistic regression , retrospective cohort study , type 2 diabetes mellitus , type 2 diabetes , confidence interval , endocrinology
The influence of socioeconomic status (SES) on health inequalities has received much attention worldwide. This study examined the effect of SES on the following older type 2 diabetes mellitus patient health outcomes: oral hypoglycemic agent (OHA) medication adherence (proportion of days covered, PDC), risk of hospitalization for diabetic macrovascular complications, and in-hospital death. A retrospective cohort design using 2013-2016 claims data was used. Subjects were 58,349 diabetes patients aged >74 years in 2013. Age, sex, residential area, and comorbidities were controlled for. Logistic regression was conducted to assess the effects of income on PDC; survival analysis was used to assess the effects on hospitalization and in-hospital death. Regressions were conducted separately by sex. Compared with the lowest income group, adjusted PDC odds ratios for medium- and high-income males, respectively, were 1.35 (95% CI: 1.27-1.43) and 1.41 (95% CI: 1.30-1.54); females: 1.17 (95% CI: 1.11-1.23) and 1.24 (95% CI: 1.13-1.35). Adjusted hazard ratios (AHRs) for male hospitalization were 0.88 (95% CI: 0.80-0.96) and 0.88 (95% CI: 0.79-0.99); females: 1.00 (95% CI: 0.93-1.07) and 0.95 (95% CI: 0.83-1.08). AHRs for male in-hospital death were 0.83 (95% CI: 0.75-0.91) and 0.62 (95% CI: 0.54-0.70); females: 0.94 (95% CI: 0.87-1.02) and 0.77 (95% CI: 0.65-0.92). Results revealed sex-specific health inequalities among older Japanese diabetes patients. Subjects with worse SES had significantly poorer OHA medication adherence (both sexes), higher hospitalization risk for diabetes complications (males), and higher in-hospital death risk (both sexes).