Social disadvantage: Its impact on the use of Medicare services related to diabetes in NSW

Objective: To use Medicare data to examine the impact of social disadvantage on the use of health services related to diabetes. Method: Information on number of diabetic individuals and number of services for select Medicare item codes were retrieved by New South Wales postcodes using a Health Insurance Commission data file. The postcodes were graded into quintiles of social disadvantage. Results: People at most social disadvantage were significantly less likely to be under the care of a general practitioner (adjusted OR 0.41; 95% CI 0.40–0.41) or consultant physician (adjusted OR 0.50; 95% CI 0.48–0.53), despite this group having the highest prevalence of diabetes. The difference in attendance to other specialists was less marked but nevertheless significant (adjusted OR 0.71; 95% CI 0.68–0.75). Once under a doctor's care, patients at most disadvantage were slightly more likely to undergo HbA1c or microalbuminuria estimation (adjusted OR 1.04; 95% CI 1.00–1.10 and adjusted OR 1.22; 95% CI 1.12–1.33, respectively) but were less likely to undergo lipid or HDL cholesterol estimation (adjusted OR 0.81; 95% CI 0.48–0.53 and adjusted OR 0.85; 95% CI 0.79–0.90, respectively). Conclusion: While access to medical care is decreased for people at most social disadvantage, once under a doctor's care they receive a level of monitoring that is relatively equal to that provided to people less disadvantaged. Implication: Strategies are required to ensure equal access to medical services for all persons with diabetes, especially for persons who are at most social and medical disadvantage.