Trends and socioeconomic disparities in diabetes prevalence and quality of care among Israeli children; 2011-2018

Yiska Loewenberg Weisband,Michal Krieger,Orly Manor,Ronit Calderon-Margalit

doi:10.1186/s13584-020-00399-w

Yiska Loewenberg Weisband, Michal Krieger + Show 2 more

Open Access

https://doi.org/10.1186/s13584-020-00399-w

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Abstract

BackgroundDespite 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 whether these changed over time.MethodsWe used repeated cross-sectional analyses in the setting of the National Program for Quality Indicators in Community Healthcare. The data were derived from electronic medical records from Israel’s four health maintenance organizations. The study population included all Israeli children aged 2–17 years in 2011–2018 (2018: N = 2,404,856). 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). We used logistic regression to assess 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.ResultsDiabetes prevalence increased with age and SEP, with a total of 3019 children with diabetes. SEP was positively associated with visiting a specialized diabetes clinic (age and sex adjusted Odds Ratio (aORSEP 4 vs. 1 2.45, 95% Confidence Interval (CI) 1.67–3.69)). Although children in higher SEPs were less likely to undergo HbA1c testing (aORSEP 4 vs. 1 0.54, 95% CI 0.40–0.72), they were also less likely to have poor glycemic control (aORSEP 4 vs. 1 0.25, 95% CI 0.18–0.34). Disparities were especially apparent among children aged 2–9 (6.5% poor glycemic control in SEP 4 vs. 38.2% in SEP 1). Poor glycemic control decreased over time, from 44.0% in 2011 to 34.1% in 2018.ConclusionsWhile poor glycemic control rates among children have improved, they remain high compared to rates in adults. Additionally, substantial 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.

Highlights

Several multi-national registries have documented increasing rates of type 1 diabetes mellitus (T1DM) in children [1, 2]
It is unclear whether this association stems from problems in access to care, or from other factors associated with low socioeconomic position (SEP)
All Israeli residents are entitled to a standardized basket of medical services, which are provided by four health maintenance organizations (HMOs), under the National Health Insurance Law

Summary

Introduction

Several multi-national registries have documented increasing rates of type 1 diabetes mellitus (T1DM) in children [1, 2]. Most European countries have shown an increase in pediatric T1DM incidence rates [3]. Large variability exists in T1DM prevalence and incidence between countries [2]. Poor glycemic control has been reported to be associated with lower socioeconomic position (SEP) in studies from the US and Europe [7,8,9]. It is unclear whether this association stems from problems in access to care, or from other factors associated with low SEP. We aimed to assess socioeconomic disparities in diabetes prevalence and quality of care among Israeli children, and to assess whether these changed over time

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