[2008年至2011年间法国普罗旺斯-阿尔卑斯-蓝色海岸地区糖尿病护理中的社会不平等趋势]

[Trends in social inequities in diabetes care in the Provence-Alpes-Côte-d'Azur region of France between 2008 and 2011].

作者信息

Casanova L, Carrier H, Martin de Vidales A, Cortaredona S, Verger P

机构信息

Aix-Marseille université, département de médecine générale, 13005 Marseille, France; Sciences économiques & sociales de la santé et traitement de l'information médicale (SESSTIM), Inserm, UMR_S 912, 13385 Marseille, France; ORS PACA, observatoire régional de la santé Provence-Alpes-Côte-d'Azur, 13006 Marseille, France.

出版信息

Rev Epidemiol Sante Publique. 2017 Feb;65(1):29-40. doi: 10.1016/j.respe.2016.10.060. Epub 2017 Jan 11.

DOI:10.1016/j.respe.2016.10.060

PMID:28089384

Abstract

BACKGROUND

Social inequities in healthcare are known to exist for the management of many chronic diseases in France, including diabetes. The recession that began in 2008 has led to increased income disparities but has it also exacerbated health inequities. The aim of this study was to describe trends in inequities in diabetes-related healthcare between 2008 and 2011 in the PACA region (Provence-Alpes-Côte-d'Azur).

METHODS

This analysis used two sources of data: the regional national health insurance fund (PACA region) reimbursement database and the socio-demographic databases of the national statistics office (INSEE) for four full years (2008 to 2011). It included individuals who had been reimbursed for three purchases of oral diabetes drugs during the previous year and assessed the association between the median household income (weighted by number and age of household members) of each patient's municipality of residence and seven indicators of diabetes monitoring and care. Using adjusted mixed logistic models, including an interaction term between time (number of years) and the median household income of the municipality, we examined the performance of the indicators for each year.

RESULTS

The total number of patients with diabetes in the 941 municipalities of the PACA region varied by year from 142,055 to 164,929. Models showed that living in a town with a high or intermediate household income was significantly associated with better performance of the seven indicators and that the interaction term was significant for six of them. The effect of the municipal median income decreased significantly between 2008 and 2011 for five indicators: HbA1c, LDL-cholesterol, microalbuminuria, ophthalmoscopy and diabetes specialist visit.

CONCLUSION

Social inequities in diabetes-related healthcare persisted between 2008 and 2011 but appeared to be decreasing, despite the recession.

摘要

背景

在法国，包括糖尿病在内的许多慢性病管理方面存在医疗保健的社会不平等现象。始于2008年的经济衰退导致收入差距加大，但这是否也加剧了健康不平等状况呢？本研究的目的是描述2008年至2011年期间普罗旺斯-阿尔卑斯-蓝色海岸大区（PACA）与糖尿病相关医疗保健方面不平等现象的趋势。

方法

该分析使用了两种数据来源：地区国家健康保险基金（PACA大区）报销数据库以及国家统计局（INSEE）连续四年（2008年至2011年）的社会人口统计学数据库。研究纳入了上一年有三次口服糖尿病药物报销记录的个体，并评估了每位患者居住市镇的家庭收入中位数（按家庭成员数量和年龄加权）与七个糖尿病监测和护理指标之间的关联。使用调整后的混合逻辑模型，包括时间（年份数）与市镇家庭收入中位数之间的交互项，我们对每年的指标表现进行了研究。

结果

PACA大区941个市镇中糖尿病患者总数每年从142,055人至164,929人不等。模型显示，生活在家庭收入高或中等的城镇与七个指标的更好表现显著相关，且其中六个指标的交互项显著。2008年至2011年期间，五个指标（糖化血红蛋白、低密度脂蛋白胆固醇、微量白蛋白尿、眼科检查和糖尿病专科就诊）的市镇收入中位数效应显著下降。