Dalhousie Medicine New Brunswick, Dalhousie University, Saint John, New Brunswick, Canada.
Department of Economics, University of New Brunswick, Fredericton, New Brunswick, Canada.
Can J Diabetes. 2022 Aug;46(6):561-568. doi: 10.1016/j.jcjd.2021.08.007. Epub 2021 Aug 21.
In the Canadian context of universal health-care coverage, income inequalities are understudied as potentially predictive of the timings and patterns of repeat hospitalizations for diabetes, despite this condition requiring self-care practices entailing appreciable out-of-pocket expenses in daily life. In this study, we examined the relationships between income disparities and risk of earlier readmission for diabetes and commonly comorbid chronic conditions in the working-age population.
The cohort study exploited 2006 population census data linked longitudinally to 3 years of hospital records from the Discharge Abstract Database among adults 25 to 64 years of age. Multiple regression survival models were used to test the associations of income group with cause-specific times to rehospitalization for diabetes (types 1 and 2) and 5 additional conditions, controlling for other individual sociodemographics.
The mean time to rehospitalization for diabetes was 223 days (N=4,540). Compared with those in the lowest income quintile, the adjusted risk of earlier readmission was significantly lower among inpatients in the highest income quintile for diabetes (hazard ratio [HR]=0.89; 95% confidence interval [CI], 0.80 to 0.99) and for the diabetes-concordant conditions of congestive heart failure (HR=0.81; 95% CI, 0.66 to 0.99) and hypertension (HR=0.85; 95% CI, 0.76 to 0.95). No significant associations between income and readmission intervals were observed for the discordant conditions of angina, asthma and chronic obstructive pulmonary disease.
Delays in rehospitalization for diabetes and concordant conditions among the most affluent suggest the persistence of income-mediated differences in individuals' ability to manage these conditions. Further research is needed to understand the specific financial burdens of disease management on patients and their households that may accelerate the risk of repeat hospitalization.
在加拿大全民医疗保健覆盖的背景下，尽管糖尿病需要自我护理，日常生活中需要自掏腰包支付相当大的费用，但收入不平等现象作为预测糖尿病再次住院时间和模式的因素，其研究还很不足。本研究调查了收入差距与工作年龄人群中糖尿病和常见合并慢性病的早期再入院风险之间的关系。
该队列研究利用 2006 年人口普查数据，纵向链接了 25 至 64 岁成年人 3 年的住院记录（来自出院摘要数据库）。使用多变量回归生存模型检验收入组与糖尿病（1 型和 2 型）和另外 5 种疾病的特定病因再住院时间之间的关联，同时控制其他个体社会人口统计学因素。
糖尿病再次住院的平均时间为 223 天（N=4540）。与收入最低的五分位数组相比，收入最高的五分位数组的住院患者糖尿病（危险比[HR]=0.89；95%置信区间[CI]，0.80 至 0.99）和与糖尿病一致的心力衰竭（HR=0.81；95%CI，0.66 至 0.99）和高血压（HR=0.85；95%CI，0.76 至 0.95）的早期再入院风险显著降低。在不匹配的心绞痛、哮喘和慢性阻塞性肺疾病的情况下，收入与再入院间隔之间没有显著关联。
最富裕人群的糖尿病和一致条件的再入院延迟表明，在个人管理这些疾病的能力方面，收入差异仍然存在。需要进一步研究以了解疾病管理对患者及其家庭的具体经济负担，这可能会加速再次住院的风险。
