Lukewich Julia, Buote Richard, Asghari Shabnam, Aubrey-Bassler Kris, Knight John, Mathews Maria
Faculty of Nursing (Lukewich), Division of Community Health and Humanities (Buote, Knight), Discipline of Family Medicine (Asghari), and Primary Healthcare Research Unit, Faculty of Medicine (Aubrey-Bassler, Knight), Memorial University of Newfoundland; Center for Rural Health Studies (Asghari); Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information, St. John's, NL; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, London, Ont.
CMAJ Open. 2020 Dec 18;8(4):E895-E901. doi: 10.9778/cmajo.20190233. Print 2020 Oct-Dec.
Although the province of Newfoundland and Labrador has the highest rates of chronic disease in Canada, the current state of many chronic diseases in the province, including diabetes mellitus, has not been well explored. We profiled the demographic characteristics associated with, and the management of, diabetes in Newfoundland and Labrador, including any rural-urban differences.
We performed a population-based, cross-sectional analysis using data from the provincial Chronic Disease Registry for fiscal year 2015/16. Patients in the study sample were 20 years of age or older, with documented identifiers for age, sex and geographic location. We examined demographic characteristics, results of screening and diabetes clinical tests (glycated hemoglobin [HbA], low-density lipoprotein [LDL] cholesterol and urine albumin-to-creatinine ratio) and hospitalization rates. We described and compared demographic, clinical and hospitalization variables across urban and rural residents of the province.
The study sample consisted of 66 325 individuals with diabetes in Newfoundland and Labrador (mean age 64.1 yr; 56.3% rural residents). Larger proportions of rural than urban residents with diabetes were aged 65 to 79 years (41.2% v. 37.5%), were female (50.2% v. 48.7%) and were identified as having the disease by laboratory tests only (19.6% v. 13.1%). Rural residents had worse clinical test outcomes than their urban counterparts, specifically with respect to HbA (mean and standard deviation [SD], 7.41% [SD 1.49] v. 7.26% [SD 1.50]) and LDL cholesterol (mean 2.46 [SD 0.95] v. mean 2.36 [SD 0.94] mmol/L). A total of 13.7% of individuals were admitted to hospital during the cohort year, with slightly more rural residents admitted for renal disease (standardized difference 0.021, 95% confidence interval 0.005 to 0.036).
For many individuals with diabetes in Newfoundland and Labrador, recommended targets for diabetes management are not being met, and residents in rural areas have poorer clinical outcomes. To inform the development and implementation of targeted provincial strategies for chronic disease management, further research is needed to determine how outcomes relate to the availability of primary health care services.
尽管纽芬兰和拉布拉多省是加拿大慢性病发病率最高的省份，但该省许多慢性病（包括糖尿病）的现状尚未得到充分研究。我们分析了纽芬兰和拉布拉多省糖尿病患者的人口统计学特征、管理情况，以及城乡之间的差异。
我们利用2015/16财年省级慢性病登记处的数据进行了一项基于人群的横断面分析。研究样本中的患者年龄在20岁及以上，记录有年龄、性别和地理位置等标识信息。我们研究了人口统计学特征、筛查结果、糖尿病临床检查结果（糖化血红蛋白[HbA]、低密度脂蛋白[LDL]胆固醇和尿白蛋白与肌酐比值）以及住院率。我们描述并比较了该省城乡居民在人口统计学、临床和住院方面的变量。
研究样本包括纽芬兰和拉布拉多省的66325名糖尿病患者（平均年龄64.1岁；56.3%为农村居民）。65至79岁的糖尿病农村居民比例高于城市居民（41.2%对37.5%）；女性比例更高（50.2%对48.7%）；仅通过实验室检查确诊患病的比例也更高（19.6%对13.1%）。农村居民的临床检查结果比城市居民更差，尤其是糖化血红蛋白（均值和标准差[SD]，7.41% [SD 1.49]对7.26% [SD 1.50]）和低密度脂蛋白胆固醇（均值2.46 [SD 0.95]对均值2.36 [SD 0.94] mmol/L）。在队列研究年度，共有13.7%的患者住院，因肾病住院的农村居民略多（标准化差异0.021，95%置信区间0.005至0.036）。
对于纽芬兰和拉布拉多省的许多糖尿病患者来说，糖尿病管理的推荐目标未达成，农村居民的临床结局更差。为了为制定和实施有针对性的省级慢性病管理策略提供信息，需要进一步研究以确定结局与初级卫生保健服务可及性之间的关系。
