Exploring regional and sociodemographic disparities associated with unenrollment for the disease management program for type 2 Diabetes Mellitus using Bayesian spatial modelling

Abstract

BackgroundThe disease management program (DMP) for type 2 Diabetes Mellitus (T2DM) is the largest DMP in Germany. Our goal was to analyze regional differences in unenrollment rates, suggest areas for intervention and provide background information, which population groups in which locations are currently not enrolled in the DMP for T2DM.MethodsIn this study, we used data of the 1.7 mil. insurants of the AOK Nordost health insurance. For the visualization of enrollment potential, we used the Besag-York-Mollie model (BYM). The spatial scan statistic (SaTScan) was used to detect areas of unusually high rates of unenrolled diabetics to prioritize areas for intervention. To explore sociodemographic associations, we used Bayesian spatial global regression models. A Spatially varying coefficient model (SVC) revealed in how far the detected associations vary over space.ResultsThe proportion of diabetics currently not enrolled in the DMP T2DM was 36.8% in 2019 and varied within northeastern Germany. Local clusters were detected mainly in Mecklenburg-West-Pomerania and Berlin. The main sociodemographic variables associated with unenrollment were female sex, younger age, being unemployed, foreign citizenship, small household size and the proportion of persons commuting to work outside their residential municipality. The SVC model revealed important spatially varying effects for some but not all associations.ConclusionLower socioeconomic status and foreign citizenship had an ubiquitous effect on not being enrolled. The DMP T2DM therefore does currently not reach those population groups, which have a higher risk for secondary diseases and possible avoidable hospitalizations. Logically, future interventions should focus on these groups. Our methodology clearly suggests areas for intervention and points out, which population group in which locations should be specifically approached.