Abstract
The influence of socioeconomic status (SES) on health inequalities has received much attention worldwide. This study examined the effect of SES on the following older type 2 diabetes mellitus patient health outcomes: oral hypoglycemic agent (OHA) medication adherence (proportion of days covered, PDC), risk of hospitalization for diabetic macrovascular complications, and in-hospital death. A retrospective cohort design using 2013–2016 claims data was used. Subjects were 58,349 diabetes patients aged >74 years in 2013. Age, sex, residential area, and comorbidities were controlled for. Logistic regression was conducted to assess the effects of income on PDC; survival analysis was used to assess the effects on hospitalization and in-hospital death. Regressions were conducted separately by sex. Compared with the lowest income group, adjusted PDC odds ratios for medium- and high-income males, respectively, were 1.35 (95% CI: 1.27–1.43) and 1.41 (95% CI: 1.30–1.54); females: 1.17 (95% CI: 1.11–1.23) and 1.24 (95% CI: 1.13–1.35). Adjusted hazard ratios (AHRs) for male hospitalization were 0.88 (95% CI: 0.80–0.96) and 0.88 (95% CI: 0.79–0.99); females: 1.00 (95% CI: 0.93–1.07) and 0.95 (95% CI: 0.83–1.08). AHRs for male in-hospital death were 0.83 (95% CI: 0.75–0.91) and 0.62 (95% CI: 0.54–0.70); females: 0.94 (95% CI: 0.87–1.02) and 0.77 (95% CI: 0.65–0.92). Results revealed sex-specific health inequalities among older Japanese diabetes patients. Subjects with worse SES had significantly poorer OHA medication adherence (both sexes), higher hospitalization risk for diabetes complications (males), and higher in-hospital death risk (both sexes).
Highlights
The relationship between socioeconomic status (SES) and health outcomes is a critical problem in social epidemiology.[1]
Findings from this study showed that lower income level, which is an important indicator of poorer SES, had a significantly negative effect on older diabetes mellitus (DM) patients’ health outcomes of oral hypoglycemic agents (OHAs) medication adherence, hospitalization for diabetic macrovascular complications, and, in-hospital mortality
This study found that males had slightly better adherence than females, both sexes exhibited a significant decrease in proportion of days covered (PDC) according to lower income level, indicating that worse SES had a significantly negative effect on older DM patients’ OHA medication adherence
Summary
The relationship between socioeconomic status (SES) and health outcomes is a critical problem in social epidemiology.[1] Some empirical studies have demonstrated an association between shorter life expectancy and SES-related health inequalities. The population of Japan has one of the longest life expectancies in the world, and the increasingly aged population is a major problem. According to an estimate by the Japan Ministry of Internal Affairs and Communications Statistics Bureau, by May 1, 2018, there were 35.3 million (28.4%), 17.7 million (14.3%), and 5.6 million (4.5%) people older than ages 65, 75, and 85 years, respectively, in Japan.[2] A National Health and Nutrition Survey conducted by the Japanese Ministry of Health, Labour and Welfare (MHLW) in 2016 showed that diabetes occurs frequently among the older population and has a substantial effect on quality of life (QOL); up to 10 million people are likely to have diabetes mellitus (DM), about 12.1% of the overall population of Japan.[3] In addition, the proportion of both male and female DM patients older than age 60 years has been increasing.[3]
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