Abstract
IntroductionDiabetes is an ambulatory care sensitive condition that can generally be managed in outpatient settings with little or no need for inpatient care. As a preliminary step to investigate whether health disparities can be detected in the inpatient setting in China, we study how diabetic patients hospitalized without prior primary care contact or with greater severity of illness differ from other diabetic inpatients along socioeconomic and clinical dimensions.MethodsWe conduct an observational study using three years of clinical data for more than 1,800 adult patients with diabetes at two tertiary hospitals in East China. Univariate analysis and probit regression are used to characterize the differences in socioeconomic and clinical factors between patients hospitalized for diabetes with no prior primary care contact and those hospitalized with previous treatment experience. Secondarily, we use ordinary least squares regression to estimate the socioeconomic and clinical differences associated with poor serum glucose control at admission.ResultsWe find that compared with patients hospitalized after prior treatment experience, inpatients with no previous primary care contact for diabetes have worse clinical laboratory values, are more likely to be young and male, to have lower education attainment, and to have poorer blood sugar control. Insurance, urban residence, and previous use of diabetic medication are in turn negatively correlated with HbA1c levels upon admission.ConclusionAmong hospitalized diabetic patients, socioeconomic factors such as lower education attainment, rural residence and lack of full insurance are associated with avoidable hospitalizations or worse indicators of health. Although we cannot definitively rule out selection bias, these findings are consistent with health disparities observable even at the inpatient level. Future studies should study the underlying mechanism by which traditionally vulnerable groups are more likely to be hospitalized for avoidable causes and with greater severity of illness.
Highlights
Diabetes is an ambulatory care sensitive condition that can generally be managed in outpatient settings with little or no need for inpatient care
We find that diabetic patients hospitalized without prior primary care treatment experience or with poorer serum control differ from other diabetic inpatients along socioeconomic and clinical lines, and are more likely to be from traditionally vulnerable groups such as those with lower education attainment, without full insurance, or with rural residence
Previous literature identified that lower education attainment is a risk factor for both pre-diabetes and diabetes in China [4,14], and our research provides preliminary evidence that these disparities may well extend into the inpatient setting, where the less educated are more likely to be admitted for hospitalizations with no prior primary care contact for the treatment of diabetes
Summary
Diabetes is an ambulatory care sensitive condition that can generally be managed in outpatient settings with little or no need for inpatient care. The world’s second largest economy that is home to nearly 20% of the global population [2], represents an important country to study the burden, and in particular inequalities in the burden of chronic illnesses such as diabetes. Diabetes is currently the eighth leading cause of mortality worldwide [6], and contributes significantly to premature mortality in low and middle-income countries [7]. It is considered an ambulatory care sensitive condition (ACSCs) that can often be effectively managed in a primary care setting. Examining the factors associated with hospitalizations for ACSCs such as diabetes can help policymakers identify vulnerable populations and formulate appropriate measures to reduce the economic, physical, and emotional burden of preventable hospitalizations
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