Chuang Wan-Chi, Chu Chih-Hsun, Hsu Ying Hsin, Yao Cai-Sin
Division of Endocrinology and Metabolism, Department of Medicine, Kaohsiung Veterans General Hospital, Kaoshiung, Taiwan, ROC.
Department of Nursing, Fooyin University, Kaohsiung, Taiwan, ROC.
J Chin Med Assoc. 2022 Mar 1;85(3):311-316. doi: 10.1097/JCMA.0000000000000685.
The Diabetes Shared Care Program (DSCP) is an integrated care model in Taiwan to improve the care quality of patients with diabetes. Socioeconomic status (SES) is one of the important factors affecting health, and it is confirmed as a predictor of various diseases and deaths.This study aimed to determine the relationship between survival rate and SES among patients who participated in the DSCP.
A cohort population-based study was conducted using the National Health Insurance Research Database of Taiwan from 2008 to 2013. The study subjects were type 2 diabetes. We defined individual SES and neighborhood SES by each patient's job category and household income, which were characterized as advantaged or disadvantaged. Then we compared the survival rates of SES groups by Cox proportional hazards model to adjust risk factors.
This study included 16 614 patients with type 2 diabetes who participated in the DSCP program. The DSCP cohort showed a high hospitalization rate in low individual SES. In terms of 10-year overall survival, DSCP participants with high individual SES living in advantaged and disadvantaged neighborhoods had lower risk of mortality than those with low SES living in advantaged and disadvantaged neighborhoods, after adjustment for age and comorbidity. DSCP participants with low individual SES living in disadvantaged neighborhoods had no significant difference of mortality as those with low individual SES living in advantaged neighborhoods.
In this study, we found that low individual SES, but not neighborhood SES, was associated with an increased mortality rate among DSCP participants.
糖尿病共享照护计划（DSCP）是台湾一种旨在提高糖尿病患者照护质量的综合照护模式。社会经济地位（SES）是影响健康的重要因素之一，并且已被确认为各种疾病和死亡的预测指标。本研究旨在确定参与DSCP的患者生存率与SES之间的关系。
利用台湾国民健康保险研究数据库进行了一项基于队列人群的研究，研究时间为2008年至2013年。研究对象为2型糖尿病患者。我们根据每位患者的职业类别和家庭收入定义个体SES和社区SES，并将其分为优势或劣势类别。然后，我们通过Cox比例风险模型比较SES组的生存率以调整风险因素。
本研究纳入了16614名参与DSCP计划的2型糖尿病患者。DSCP队列中个体SES较低者住院率较高。在10年总生存率方面，在调整年龄和合并症后，居住在优势和劣势社区的个体SES较高的DSCP参与者的死亡风险低于居住在优势和劣势社区的个体SES较低者。居住在劣势社区的个体SES较低的DSCP参与者与居住在优势社区的个体SES较低者的死亡率无显著差异。
在本研究中，我们发现个体SES较低而非社区SES与DSCP参与者死亡率增加有关。
