Department of Health Promotion, Daegu University, 201 Daegudae-ro, Gyeongsan, Gyeongbuk 38453, Republic of Korea.
Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, 10240 Kingsway Avenue NW, Edmonton, Alberta T5H 3V9, Canada.
Diabetes Res Clin Pract. 2017 May;127:205-211. doi: 10.1016/j.diabres.2017.02.024. Epub 2017 Feb 23.
Diabetic retinopathy (DR) is a leading cause of blindness in Canada. Despite established comprehensive guidelines for routine DR screening, the rate of provision of diabetic eye care services by ophthalmologists in Alberta decreased in past years. The aim of this study was to examine socioeconomic status (SES)-related inequalities in the use of eye care services for patients with diabetes in Alberta, Canada.
We used data from the Alberta Diabetes Surveillance System (ADSS), including visits to ophthalmologists over a 15-year period (1995-2009). Socioeconomic inequalities in the use of eye care services were assessed using the Relative Concentration Index (RCI). We used three different SES indicators: median household income and the Canadian material and social deprivation indices (MDI and SDI).
Socioeconomic inequalities in use of eye care services exist in patients with diabetes, although the magnitudes of the inequalities were small and steadily decreased over time; income- and MDI-related RCI indicated that individuals with greater income or less material deprivation were more likely to use eye care services. However, for SDI-related RCI, socially deprived individuals were more likely to use eye care services (RCI: 1995: -0.066; 2002: -0.036; 2009: -0.028).
Our findings suggest a need for attention to the potential impact of provincial policy on inequalities in eye care services among patients with diabetes, particularly as it relates to geographical differences across regional health zones.
糖尿病视网膜病变(DR)是加拿大导致失明的主要原因。尽管已经制定了针对常规 DR 筛查的综合指南,但阿尔伯塔省眼科医生提供糖尿病眼病护理服务的比例在过去几年中有所下降。本研究旨在检查加拿大阿尔伯塔省糖尿病患者接受眼科保健服务的利用情况与社会经济地位(SES)之间的关系。
我们使用了来自阿尔伯塔省糖尿病监测系统(ADSS)的数据,包括 15 年来(1995-2009 年)对眼科医生的就诊情况。使用相对集中指数(RCI)评估眼科保健服务利用方面的社会经济不平等情况。我们使用了三种不同的 SES 指标:家庭收入中位数和加拿大物质和社会剥夺指数(MDI 和 SDI)。
糖尿病患者的眼科保健服务利用存在社会经济不平等,但不平等的幅度较小,且随着时间的推移逐渐减小;收入和 MDI 相关的 RCI 表明,收入较高或物质剥夺程度较低的个体更有可能利用眼科保健服务。然而,对于 SDI 相关的 RCI,社会贫困者更有可能利用眼科保健服务(RCI:1995 年:-0.066;2002 年:-0.036;2009 年:-0.028)。
我们的研究结果表明,需要关注省级政策对糖尿病患者眼科保健服务利用不平等的潜在影响,特别是在区域卫生区域之间的地理差异方面。