Abstract
BackgroundLow income appears to be associated with a higher prevalence of diabetes and diabetes related complications, however, little is known about how income influences access to diabetes care. The objective of the present study was to determine whether income is associated with referral to a diabetes centre within a universal health care system.MethodsData on referral for diabetes care, diabetes prevalence and median household income were obtained from a regional Diabetes Education Centre (DEC) database, the Canadian National Diabetes Surveillance System (NDSS) and the 2001 Canadian Census respectively. Diabetes rate per capita, referral rate per capita and proportion with diabetes referred was determined for census dissemination areas. We used Chi square analyses to determine if diabetes prevalence or population rates of referral differed across income quintiles, and Poisson regression to model diabetes rate and referral rate in relation to income while controlling for education and age.ResultsThere was a significant gradient in both diabetes prevalence (χ2 = 743.72, p < 0.0005) and population rates of referral (χ2 = 168.435, p < 0.0005) across income quintiles, with the lowest income quintiles having the highest rates of diabetes and referral to the DEC. Referral rate among those with diabetes, however, was uniform across income quintiles. Controlling for age and education, Poisson regression models confirmed a significant socio-economic gradient in diabetes prevalence and population rates of referral.ConclusionLow income is associated with a higher prevalence of diabetes and a higher population rate of referral to this regional DEC. After accounting for diabetes prevalence, however, the equal proportions referred to the DEC across income groups suggest that there is no access bias based on income.
Highlights
Low income appears to be associated with a higher prevalence of diabetes and diabetes related complications, little is known about how income influences access to diabetes care
This table includes the diabetes prevalence, population rate of Diabetes Education Centre (DEC) referral and the proportion with diabetes referred to the DEC per income quintile
Referral among those with known diabetes, appears to be uniform across income quintiles with approximately 14% of patients with diabetes being referred to the DEC in the two year period studied
Summary
Low income appears to be associated with a higher prevalence of diabetes and diabetes related complications, little is known about how income influences access to diabetes care. The objective of the present study was to determine whether income is associated with referral to a diabetes centre within a universal health care system. Low income is associated with an increased rate of hospitalization for acute diabetes related complications. Booth and Hux [7] demonstrated that, even within a universal health care system, the least affluent patients were admitted to hospital 43% more often than the wealthiest patients. They identified lack of physician directed ambulatory care as a major determinant of hospitalization in patients with diabetes
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