Socioeconomic disparities in diabetes prevalence and quality of care among Israeli children

Abstract

Abstract Background Despite Israel’s universal health coverage, disparities in health services provision may still exist. We aimed to assess socioeconomic disparities in diabetes prevalence and quality of care among Israeli children, and to assess trends in these over time. Methods Repeated cross-sectional analyses in the setting of the National Program for Quality Indicators in Community Healthcare that receives data based on electronic medical records from Israel’s four health maintenance organizations. The study population included all Israeli children aged 2-19 years in 2011-2017 (for 2017: N = 2,364,374, including 2,914 with diabetes). Socio-economic position (SEP) was measured using Central Bureau of Statistics data further updated by a private company (Points Business Mapping Ltd), and grouped into 4 categories, ranging from 1 (lowest) to 4 (highest). Using logistic regression, we assessed the association of SEP with diabetes prevalence, diabetes clinic visits, hemoglobin A1C (HbA1C) testing, and poor glycemic control (HbA1C> 9%), and assessed whether these changed over time. Models were adjusted for age, and sex. Results Diabetes prevalence increased with age and SEP. SEP was positively associated with visiting a specialized diabetes clinic (OR SEP 4 vs. 1 2.53, 95% CI 1.72 - 3.70). Odds of HbA1C testing and odds of poor glycemic control were negatively associated with SEP (OR SEP 4 vs. 1: 0.54, 95% CI 0.40 - 0.72 and OR SEP 4 vs. 1: 0.25, 95% CI 0.18 - 0.34 respectively). Disparities were especially apparent among children aged 2-9 (4.6% poor glycemic control in SEP 4 vs. 40.8% in SEP 1). Poor glycemic control decreased over time, from 44.0% in 2011 to 34.8% in 2017. Conclusions While poor glycemic control rates among children have improved, significant socioeconomic gaps remain. It is eminent to study the causes of these disparities and develop policies to improve care provided to children in the lower SEP levels, to promote health equity. Key messages Major socioeconomic inequalities in the control of diabetes among children in Israel remain despite universal health care coverage. The rate of uncontrolled diabetes among Israeli children has improved over time.