Toivakka Maija, Laatikainen Tiina, Kumpula Timo, Tykkyläinen Markku
Department of Geographical and Historical Studies, University of Eastern Finland, P.O. Box 111, 80101, Joensuu, Finland.
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
Int J Health Geogr. 2015 Sep 30;14:27. doi: 10.1186/s12942-015-0020-x.
Type 2 diabetes is a major health concern all over the world. The prevention of diabetes is important but so is well-balanced diabetes care. Diabetes care can be influenced by individual and neighborhood socio-economic factors and geographical accessibility to health care services. The aim of the study is to find out whether two different area classifications of urban and rural areas give different area-level results of achieving the targets of control and treatment among type 2 diabetes patients exemplified by a Finnish region. The study exploits geo-referenced patient data from a regional primary health care patient database combined with postal code area-level socio-economic variables, digital road data and two grid based classifications of areas: an urban-rural dichotomy and a classification with seven area types.
The achievement of control and treatment targets were assessed using the patient's individual laboratory data among 9606 type 2 diabetes patients. It was assessed whether hemoglobin A1c (HbA1c) was controlled and whether the recommended level of HbA1c was achieved in patients by different area classes and as a function of distance. Chi square test and logistic regression analysis were used for testing.
The study reveals that area-level inequalities exist in the care of type 2 diabetes in a detailed 7-class area classification but if the simple dichotomy of urban and rural is applied differences vanish. The patient's gender and age, area-level education and the area class they belonged to were associated with achievements of control and treatment targets. Longer distance to health care services was not a barrier to good achievements of control or treatment targets.
A more detailed grid-based area classification is better for showing spatial differences in the care of type 2 diabetes patients. Inequalities exist but it would be misleading to state that the differences are simply due to urban or rural location or due to distance. From a planning point of view findings suggest that detailed geo-coded patient information could be utilized more in resourcing and targeting the health care services to find the area-level needs of care and to improve the cost-efficient allocation of resources.
2型糖尿病是全球主要的健康问题。糖尿病的预防很重要，但均衡的糖尿病护理同样重要。糖尿病护理会受到个人及社区社会经济因素以及获得医疗服务的地理可达性的影响。本研究的目的是，以芬兰一个地区为例，探究城乡两种不同的区域分类在2型糖尿病患者实现控制和治疗目标方面是否会得出不同的区域层面结果。该研究利用了来自区域初级卫生保健患者数据库的地理参考患者数据，并结合邮政编码区域层面的社会经济变量、数字道路数据以及两种基于网格的区域分类：城乡二分法和七种区域类型的分类。
利用9606例2型糖尿病患者的个人实验室数据评估控制和治疗目标的达成情况。评估不同区域类别以及作为距离函数的患者中糖化血红蛋白（HbA1c）是否得到控制以及是否达到推荐的HbA1c水平。使用卡方检验和逻辑回归分析进行检验。
研究表明，在详细的七类区域分类中，2型糖尿病护理存在区域层面的不平等，但如果采用简单的城乡二分法，差异就会消失。患者的性别和年龄、区域层面的教育程度以及他们所属的区域类别与控制和治疗目标的达成情况相关。距离医疗服务机构较远并非控制或治疗目标良好达成的障碍。
更详细的基于网格的区域分类更有利于显示2型糖尿病患者护理中的空间差异。不平等现象存在，但简单地说差异仅仅是由于城市或农村位置或距离造成的，这会产生误导。从规划角度来看，研究结果表明，在资源配置和将医疗服务定向到区域层面的护理需求以及改善资源的成本效益分配方面，可以更多地利用详细的地理编码患者信息。
