Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
Int J Gen Med. 2015 Feb 25;8:87-92. doi: 10.2147/IJGM.S77139. eCollection 2015.
Low socioeconomic status is associated with higher prevalence of diabetes, worse outcomes, and worse quality of care. We explored the relationship between education, as a measure of socioeconomic status, and quality of care in the Swiss context.
Data were drawn from a population-based survey of 519 adults with diabetes during fall 2011 and summer 2012 in a canton of Switzerland. We assessed patients and diabetes characteristics. Eleven indicators of quality of care were considered (six of process and five of outcomes of care). After bivariate analyses, regression analyses adjusted for age, sex, and diabetic complications were performed to assess the relationship between education and quality of care.
Of 11 quality-of-care indicators, three were significantly associated with education: funduscopy (patients with tertiary versus primary education were more likely to get the exam: odds ratio, 1.8; 95% confidence interval [CI], 1.004-3.3) and two indicators of health-related quality of life (patients with tertiary versus primary education reported better health-related quality of life: Audit of Diabetes-Dependent Quality of Life: β=0.6 [95% CI, 0.2-0.97]; SF-12 mean physical component summary score: β=3.6 [95% CI, 0.9-6.4]).
Our results suggest the presence of educational inequalities in quality of diabetes care. These findings may help health professionals focus on individuals with increased needs to decrease health inequalities.
社会经济地位较低与糖尿病患病率较高、预后较差和医疗质量较差有关。我们在瑞士背景下探讨了教育作为社会经济地位的衡量标准与医疗质量之间的关系。
数据来自于 2011 年秋季和 2012 年夏季瑞士一个州的一项基于人群的 519 例糖尿病成人调查。我们评估了患者和糖尿病特征。考虑了 11 项医疗质量指标（其中 6 项为护理过程指标，5 项为护理结局指标）。在进行了单变量分析后，我们进行了回归分析，对年龄、性别和糖尿病并发症进行了调整，以评估教育与医疗质量之间的关系。
在 11 项医疗质量指标中，有 3 项与教育显著相关：眼底检查（接受过高等教育的患者比接受过初级教育的患者更有可能接受该检查：优势比，1.8；95%置信区间[CI]，1.004-3.3）和两个与健康相关的生活质量指标（接受过高等教育的患者比接受过初级教育的患者报告的健康相关生活质量更好：糖尿病依赖生活质量评估：β=0.6[95%CI，0.2-0.97]；SF-12 平均生理成分综合评分：β=3.6[95%CI，0.9-6.4]）。
我们的结果表明，糖尿病医疗质量存在教育不平等现象。这些发现可能有助于卫生专业人员关注需要增加的个体，以减少健康不平等。
