Abstract
IntroductionQuality of care could be influenced by individual socio-economic status (SES) and by residential area deprivation. The objective is to synthesize the current evidence regarding inequalities in health care for patients with Type 2 diabetes mellitus (Type 2 DM).MethodsThe systematic review focuses on inequalities concerning process (e.g. measurement of HbA1c, i.e. glycolised haemoglobin) and intermediate outcome indicators (e.g. HbA1c level) of Type 2 diabetes care. In total, of n = 886 publications screened, n = 21 met the inclusion criteria.ResultsA wide variety of definitions for ‘good quality diabetes care’, regional deprivation and individual SES was observed. Despite differences in research approaches, there is a trend towards worse health care for patients with low SES, concerning both process of care and intermediate outcome indicators. Patients living in deprived areas less often achieve glycaemic control targets, tend to have higher blood pressure (BP) and worse lipid profile control.ConclusionThe available evidence clearly points to the fact that socio-economic inequalities in diabetes care do exist. Low individual SES and residential area deprivation are often associated with worse process indicators and worse intermediate outcomes, resulting in higher risks of microvascular and macrovascular complications. These inequalities exist across different health care systems. Recommendations for further research are provided.
Highlights
Quality of care could be influenced by individual socio-economic status (SES) and by residential area deprivation
We focused the review on process indicators such as assessment of Glycolised haemoglobin (HbA1c), blood pressure (BP), Body mass index (BMI), and on intermediate outcome indicators such as quantitative measurement of HbA1c, BP and/or lipids in the blood
The available evidence clearly points to the fact that socio-economic inequalities in diabetes care do exist
Summary
Quality of care could be influenced by individual socio-economic status (SES) and by residential area deprivation. The data from the United Kingdom Prospective Diabetes Study (UKPDS) concerning patients with Type 2. Socio-economic status (SES) may influence access to and quality of care, social support and availability of community resources. It may influence diabetes-related knowledge, communication with providers, treatment choices and the ability to adhere to recommended medication, exercise and dietary regimens [4,5]. Some analyses focusing on patients with Type 2 DM indicate that health care could be worse for low SES groups, but this has rarely been studied in a systematic way
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