Impact of socio-economic position on health and quality of care in adults with Type 2 diabetes in France: the Entred 2007 study

• Published in: Diabetic medicine 2015-11, Vol.32 (11), p.1438-1444
• Main Authors: Fosse-Edorh, S., Fagot-Campagna, A., Detournay, B., Bihan, H., Eschwege, E., Gautier, A., Druet, C.
• Format: Article
• Language: English
• Subjects: Aged; Body Mass Index; Combined Modality Therapy - economics; Cross-Sectional Studies; Delayed Diagnosis; Diabetes; Diabetes Complications - diagnosis; Diabetes Complications - economics; Diabetes Complications - epidemiology; Diabetes Complications - prevention & control; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - therapy; Diabetic Cardiomyopathies - complications; Diabetic Cardiomyopathies - economics; Diabetic Cardiomyopathies - epidemiology; Diabetic Cardiomyopathies - prevention & control; Diabetic Foot - complications; Diabetic Foot - economics; Diabetic Foot - epidemiology; Diabetic Foot - prevention & control; Female; France - epidemiology; Health Care Costs; Health Status; Health Surveys; Humans; Male; Middle Aged; Obesity - complications; Obesity - economics; Obesity - epidemiology; Obesity - prevention & control; Quality of Health Care; Risk Factors; Socioeconomic Factors
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12783

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 (HbA1c > 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. What's new? People with Type 2 diabetes who reported encountering financial difficulties were more likely to be smokers, to be obese and to have poorer glycaemic control. The lower the socio‐economic position in people with Type 2 diabetes, the higher the prevalence of podiatric and coronary complications. Despite the fact that people with the lowest socio‐economic position benefit more from full healthcare coverage, patterns of healthcare in this population are different, with greater use of general practitioners and less frequent use of specialists.