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Impact of socio‐economic position on health and quality of care in adults with Type 2 diabetes in France: the Entred 2007 study
Author(s) -
FosseEdorh S.,
FagotCampagna A.,
Detournay B.,
Bihan H.,
Eschwege E.,
Gautier A.,
Druet C.
Publication year - 2015
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12783
Subject(s) - odds ratio , medicine , odds , diabetes mellitus , type 2 diabetes , confidence interval , cross sectional study , health care , demography , gerontology , logistic regression , endocrinology , pathology , sociology , economic growth , economics
Aim To describe the association between socio‐economic position, health status and quality of diabetes care in people with Type 2 diabetes in France, where people may receive full healthcare coverage for chronic disease. Methods Data from a national cross‐sectional survey performed in people pharmacologically treated for diabetes were used. They combined data from medical claims, hospital discharge, questionnaires for patients ( n = 3894 with Type 2 diabetes) and their physicians ( n = 2485). Socio‐economic position was assessed using educational level (low, intermediate, high) and ability to make ends meet (financial difficulties vs. financially comfortable). Results People with diabetes reporting financial difficulties were more likely to be smokers (adjusted odds ratio 1.4; 95% CI 1.1–1.6) and obese (adjusted odds ratio 1.3; 95% CI 1.2–1.6) and to have poorer glycaemic control (HbA 1c > 64 mmol/mol (8%); adjusted odds ratio 1.4; 95% CI 1.1–1.8), than those who were financially comfortable. They were more likely to have their diabetes diagnosed because of complications (adjusted odds ratio 1.6; 95% CI 1.3–2.0). They were also more likely to have coronary and podiatric complications (adjusted odds ratios 1.3; 95% CI 1.1–1.6 and 1.7; 95% CI 1.4–2.2, respectively). They benefited more often from full coverage (adjusted odds ratio 1.3; 95% CI 1.1–1.6), visited general practitioners more often (ratio of estimated marginal means 1.2; 95% CI 1.1–1.2) but specialists less often (adjusted odds ratio 0.7; 95% CI 0.6–0.8 for a visit to private ophthalmologist). They also felt less well informed about their condition. Conclusions Despite frequent access to full healthcare coverage, socio‐economic position has an impact on the diagnosis of diabetes, health status and quality of diabetes care in France.