Department of Medicine, University of Toronto, Toronto, ON, Canada.
Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Diabet Med. 2020 May;37(5):822-827. doi: 10.1111/dme.14051. Epub 2019 Jul 4.
To examine whether income-related disparities in glycaemic control decline after the age of 65 years, when publicly funded universal drug insurance is acquired in Ontario, Canada.
We conducted a population-based cross-sectional study using linked administrative healthcare databases. Adults with diabetes, aged 40-89 years, with available HbA data were included (N = 716 297). Income was based on median neighbourhood household income. Multiple linear regression was used to test for effect modification of age ≥65 years on the relationship between income and HbA .
There was a significant inverse association between income and HbA level. After adjusting for baseline factors, the effect of income on HbA level was significantly greater for individuals aged <65 years (mean difference HbA for lowest vs highest income group +2.5 mmol/mol, 95% CI +2.3 to +2.7 [+0.23%, 95% CI 0.21 to 0.24]) than for those aged ≥65 years (+1.2 mmol/mol, 95% CI +1.0 to +1.3 [+0.11%, 95% CI 0.10 to 0.12]; P < 0.0001 for interaction).
Despite universal access to healthcare, people with diabetes with lower incomes had significantly worse glycaemic control compared with their counterparts on higher incomes. However, income gradients in glycaemic control were markedly reduced after the age of 65 years, possibly as a result of access to prescription drug coverage.
在加拿大安大略省获得公共资助的全民药物保险后（即年满 65 岁），研究血糖控制方面的收入相关差距是否会缩小。
我们使用链接的行政医疗保健数据库进行了一项基于人群的横断面研究。纳入年龄在 40-89 岁、有 HbA 数据的糖尿病患者（N=716297）。收入基于邻里家庭收入中位数。采用多元线性回归检验年龄≥65 岁对收入与 HbA 之间关系的修饰作用。
收入与 HbA 水平呈显著负相关。在调整基线因素后，对于年龄<65 岁的个体，收入对 HbA 水平的影响明显更大（最低与最高收入组之间的 HbA 差异为+2.5 mmol/mol，95%置信区间为+2.3 至+2.7[+0.23%，95%置信区间为 0.21 至 0.24]），而对于年龄≥65 岁的个体，这一差异为+1.2 mmol/mol，95%置信区间为+1.0 至+1.3[+0.11%，95%置信区间为 0.10 至 0.12]；P<0.0001 交互作用）。
尽管可以全民获得医疗保健，但收入较低的糖尿病患者的血糖控制明显差于收入较高的患者。然而，在 65 岁之后，血糖控制方面的收入梯度明显缩小，这可能是由于获得了处方药保险。
