Effect of socioeconomic status on survival in patients on the Diabetes Shared Care Program: Finding from a Taiwan nationwide cohort.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

In this study, we found that low individual SES, but not neighborhood SES, was associated with an increased mortality rate among DSCP participants.