Helmholtz Zentrum Muenchen, Institute of Health Economics and Health Care Management, PO Box 1129, Neuherberg D-85758, Germany.
Int J Equity Health. 2014 Jun 2;13:43. doi: 10.1186/1475-9276-13-43.
Quality 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).
The 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.
A 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.
The 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.
医疗质量可能受到个体社会经济地位（SES）和居住地区贫困程度的影响。本研究旨在综合当前有关 2 型糖尿病患者医疗保健不平等的证据。
系统综述重点关注 2 型糖尿病护理过程（例如糖化血红蛋白即糖基化血红蛋白的测量）和中间结果指标（例如 HbA1c 水平）的不平等问题。在总共筛选出的 n = 886 篇文献中，n = 21 篇符合纳入标准。
观察到“优质糖尿病护理”、区域贫困和个体 SES 的定义多种多样。尽管研究方法存在差异，但社会经济地位较低的患者在护理过程和中间结果指标方面的医疗保健质量往往更差。居住在贫困地区的患者血糖控制目标较难实现，血压和血脂控制情况往往较差。
现有证据清楚地表明，糖尿病护理中确实存在社会经济不平等现象。个体 SES 较低和居住地区贫困往往与较差的过程指标和较差的中间结果相关，导致微血管和大血管并发症的风险增加。这些不平等现象存在于不同的医疗保健系统中。提供了进一步研究的建议。
Zotero 插件