Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2, Seto, Kanazawa-ku, Yokohama, Kanagawa, 236-0027, Japan.
Department of Endocrinology, Tenri Hospital, 200 Mishimacho, Nara, Tenri, Japan.
Acta Diabetol. 2022 Jun;59(6):793-801. doi: 10.1007/s00592-022-01869-0. Epub 2022 Mar 12.
Workplace demands, support, and relationships differ according to employment status (e.g., employment that is full-time, part-time, or self-employed) and may lead to unequal opportunities to keep diabetic appointments. We investigated the association between employment status and outpatient diabetic appointment non-attendance among working-age adults with type 2 diabetes.
This was a secondary analysis of a cluster-randomized trial (the Japan diabetes outcome intervention trial 2 large-scale trial). The analysis included 2010 trial participants (40-65 years old) with type 2 diabetes who were regularly followed by primary care physicians (PCPs). The outcome measure was the first non-attendance (defined as a failure to visit a PCP within 2 months of the original appointment) during the one-year follow-up. The association between baseline employment status and non-attendance was examined using Cox proportional hazard model in men and women.
During the 1279 and 789 person-year follow-up periods, 90 men and 34 women, respectively, experienced their first appointment non-attendance. Among men, self-employed participants had a higher risk of non-attendance compared with full-time employees (adjusted HR, 1.84; 95% CI, 1.15, 2.95). The trial intervention (attendance promotion) was associated with a significantly reduced risk of non-attendance among self-employed participants (HR, 0.51; 95% CI, 0.26, 0.99). Among women, a significant association between employment status and non-attendance was not observed.
Self-employed men with type 2 diabetes had a twofold increased risk of non-attendance than did full-time employees. Our study suggests that self-employed men with type 2 diabetes should be targeted for interventions promoting appointment adherence.
工作场所的需求、支持和关系因就业状况（例如全职、兼职或自雇）而异，这可能导致保持糖尿病预约的机会不平等。我们调查了就业状况与 2 型糖尿病成年工作人群门诊糖尿病预约失约之间的关系。
这是一项对（日本糖尿病结局干预试验 2 大规模试验）的聚类随机试验的二次分析。该分析纳入了 2010 年试验参与者（40-65 岁），他们定期接受初级保健医生（PCP）的随访。结局指标为随访 1 年内的首次失约（定义为在原预约后 2 个月内未就诊于 PCP）。采用 Cox 比例风险模型，在男性和女性中分别检验基线就业状况与失约的关系。
在 1279 和 789 人年随访期间，分别有 90 名男性和 34 名女性经历了首次预约失约。在男性中，与全职员工相比，自雇参与者的失约风险更高（调整后的 HR，1.84；95%CI，1.15，2.95）。试验干预（促进就诊）与自雇参与者的失约风险显著降低相关（HR，0.51；95%CI，0.26，0.99）。在女性中，就业状况与失约之间无显著关联。
2 型糖尿病的自雇男性比全职员工失约风险高两倍。我们的研究表明，应针对 2 型糖尿病的自雇男性进行干预以促进预约依从性。
