Yang Shih-Hsien, Chen Su-Feng, Nieh Shin, Liu Chia-Lin, Lin Yaoh-Shiang, Lee Ching-Chih, Lin Fu-Huang
Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
Department of Medical Administration Office, National Defense Medical Center & Tri-Service General Hospital Beitou Branch, Taipei, Taiwan.
PLoS One. 2017 Jan 12;12(1):e0169550. doi: 10.1371/journal.pone.0169550. eCollection 2017.
Diabetes mellitus (DM) is a global pandemic metabolic disorder. In recent years, the amount of medical resources required for the treatment of diabetes has increased as diabetes rates have gradually risen. The combined effects of individual and neighbourhood socio-economic status (SES) on DM survival rates are still not clear, especially in patients of working age. In this paper, we aim to analyze the combined effects of neighbourhood and individual SES on DM survival rates in patients of working age in Taiwan.
The study of 23,781 people who were diagnosed with DM by using population-based study between 2002 and 2006. Each sample was followed up for 4 years or as a sensor case. We defined Individual SES and neighbourhood SES by each patient's job category and household income which characterized as advantaged or disadvantaged. Then we compared the survival rates by SES group used Cox proportional hazards model for adjust risk factors.
The 4-year overall survival rates of diabetic patients were worst for those with low individual SES who living in advantaged neighbourhoods. After adjustment for patient characteristics, DM patients with high individual SES living in disadvantaged neighbourhoods had the same risk of mortality as those patients with high individual SES living in advantaged neighbourhoods (hazard ratio: 1.11; 95% confidence interval [CI]: 0.81-1.51). The study found that DM patients with low individual SES who live in disadvantaged areas had a greater risk of mortality than those with high SES (odds ratio: 2.57; 95% CI: 2.04-3.24). There were significant differences in survival rates between patients with high individual SES and patients with low individual SES. In contrast, the results did not statistically significant differences in survival rates between advantaged and disadvantaged neighbourhood SES groups.
DM patients with low individual SES had the worst survival rate, regardless of whether they were living in a high or low SES neighbourhood area. The competitive cause of death, i.e., the fact that complications, rather than DM itself, are often the cause of death, may be the reason for the inverse relationship found between the effects of individual SES and neighbourhood SES on DM survival. We conclude that the socio-economic gradient in survival among DM patients may be the result of differences in access to medical treatment and attributes related to individual SES.
糖尿病（DM）是一种全球性的大流行性代谢紊乱疾病。近年来，随着糖尿病发病率逐渐上升，治疗糖尿病所需的医疗资源数量也有所增加。个体和社区社会经济地位（SES）对糖尿病生存率的综合影响仍不明确，尤其是在工作年龄的患者中。在本文中，我们旨在分析台湾工作年龄糖尿病患者的社区和个体SES对其生存率的综合影响。
采用基于人群的研究方法，对2002年至2006年间被诊断为糖尿病的23781人进行研究。每个样本随访4年或直至出现检测病例。我们根据每位患者的工作类别和家庭收入来定义个体SES和社区SES，将其分为优势或劣势类别。然后我们使用Cox比例风险模型对风险因素进行调整，比较不同SES组的生存率。
个体SES低且生活在优势社区的糖尿病患者4年总生存率最差。在对患者特征进行调整后，个体SES高且生活在劣势社区的糖尿病患者与个体SES高且生活在优势社区的患者死亡率风险相同（风险比：1.11；95%置信区间[CI]：0.81 - 1.51）。研究发现，个体SES低且生活在劣势地区的糖尿病患者比SES高的患者有更高的死亡风险（优势比：2.57；95% CI：2.04 - 3.24）。个体SES高的患者和个体SES低的患者在生存率上存在显著差异。相比之下，优势和劣势社区SES组之间的生存率在统计学上没有显著差异。
个体SES低的糖尿病患者生存率最差，无论他们生活在高SES还是低SES社区。竞争性死亡原因，即并发症而非糖尿病本身往往是死亡原因这一事实，可能是个体SES和社区SES对糖尿病生存率影响之间呈反比关系的原因。我们得出结论，糖尿病患者生存中的社会经济梯度可能是获得医疗治疗机会的差异以及与个体SES相关属性的结果。
