The Research Institute of the McGill University Health Centre, Montreal, Québec, Canada.
Department of Pediatrics, McGill University, Montreal, Québec, Canada.
JAMA Netw Open. 2022 May 2;5(5):e2210464. doi: 10.1001/jamanetworkopen.2022.10464.
Insulin pumps improve glycemic control and quality of life in children with type 1 diabetes (T1D). Canada's provinces have implemented universal pediatric programs to improve access. However, these programs provide differing financial coverage, allowing for unique cross-jurisdictional comparisons.
To evaluate possible socioeconomic status (SES) disparities in pump uptake in Québec, where pumps are fully funded, with those in Manitoba, where pumps are partially funded.
DESIGN, SETTING, AND PARTICIPANTS: Using health administrative databases and a clinical registry, parallel, population-based cohort studies of children with diabetes were conducted from April 1, 2011, in Québec, and April 1, 2012, in Manitoba, until March 31, 2017. In analysis conducted from July 1, 2019, to November 30, 2021, multivariable Cox proportional hazards regression models were applied to study the association between pump uptake and SES, defined using validated area-based material and social deprivation indices. Children aged 1 to 17 years with T1D were identified using a validated definition in administrative data (Québec) and a clinical registry (Manitoba). Those using pumps before the initiation of provincial programs were excluded.
Socioeconomic status.
Insulin pump uptake.
A total of 2919 children with T1D were identified in Québec: 1550 male (53.1%), mean (SD) age at diagnosis, 8.3 (4.4) years, and 1067 (36.6%) were using a pump. In Manitoba, 636 children were identified: 364 male (57.2%), mean (SD) age at diagnosis, 8.8 (4.4) years, and 106 (16.7%) were using a pump. In Québec, the mean age at diagnosis of T1D was lower in children using the pump compared with those not using a pump (7.6 [4.1] vs 8.7 [4.5] years); sex distribution was similar (562 [52.7%] vs 988 [53.3%] male). No differences in mean (SD) age at diagnosis (8.8 [4.4] vs 8.8 [4.3] years) or sex (57 [53.8%] vs 307 [57.9%] male) were noted in both groups in Manitoba. Increasing material deprivation was associated with decreased pump uptake in both Québec (adjusted hazard ratio [aHR] 0.89; 95% CI, 0.85-0.93) and Manitoba (aHR, 0.70; 95% CI, 0.60-0.82). Inclusion of ethnic concentration did not change this association. Socioeconomic disparities in pump uptake were greater in Manitoba than Québec (P = .006 by t test; Cochran Q, 8.15; P = .004; I2 = 87.7%; 95% CI, 52.5%-96.8%).
The results of this study suggest that the program of full coverage for pumps available in Québec partially mitigates observed SES disparities in uptake and may be a model to improve access for all children with T1D.
胰岛素泵可改善 1 型糖尿病（T1D）儿童的血糖控制和生活质量。加拿大各省已实施普及儿科计划以改善获取途径。然而，这些计划提供了不同的财务覆盖范围，允许进行独特的跨司法管辖区比较。
评估在安大略省（胰岛素泵完全由政府资助）和马尼托巴省（胰岛素泵部分由政府资助），社会经济地位（SES）差异对胰岛素泵使用率的可能影响。
设计、地点和参与者：使用健康行政数据库和临床登记处，对 2011 年 4 月 1 日至 2017 年 3 月 31 日期间在安大略省和 2012 年 4 月 1 日至 2017 年 3 月 31 日期间在马尼托巴省的糖尿病儿童进行了平行、基于人群的队列研究。在 2019 年 7 月 1 日至 2021 年 11 月 30 日进行的分析中，使用多变量 Cox 比例风险回归模型研究了 SES 与泵使用率之间的关联，SES 使用经过验证的基于区域的物质和社会剥夺指数来定义。使用行政数据（安大略省）和临床登记处（马尼托巴省），使用经过验证的定义来识别 1 至 17 岁患有 T1D 的儿童。在省级计划启动之前使用泵的儿童被排除在外。
社会经济地位。
胰岛素泵使用率。
在安大略省共确定了 2919 名患有 T1D 的儿童：1550 名男性（53.1%），诊断时的平均（SD）年龄为 8.3（4.4）岁，1067 名（36.6%）正在使用胰岛素泵。在马尼托巴省，共确定了 636 名儿童：364 名男性（57.2%），诊断时的平均（SD）年龄为 8.8（4.4）岁，106 名（16.7%）正在使用胰岛素泵。在安大略省，使用胰岛素泵的 T1D 儿童的平均诊断年龄低于未使用胰岛素泵的儿童（7.6[4.1]岁 vs 8.7[4.5]岁）；性别分布相似（562[52.7%] vs 988[53.3%]男性）。在马尼托巴省，两组的平均（SD）诊断年龄（8.8[4.4]岁 vs 8.8[4.3]岁）或性别（57[53.8%] vs 307[57.9%]男性）均无差异。在安大略省和马尼托巴省，物质剥夺程度的增加与泵使用率的降低有关（安大略省调整后的危险比[aHR]为 0.89；95%CI，0.85-0.93；马尼托巴省 aHR 为 0.70；95%CI，0.60-0.82）。纳入种族集中并没有改变这种关联。在马尼托巴省，泵使用率的社会经济差异大于安大略省（P=0.006，检验；Cochran Q，8.15；P=0.004；I2=87.7%；95%CI，52.5%-96.8%）。
这项研究的结果表明，安大略省提供的胰岛素泵全额覆盖计划部分减轻了观察到的使用率方面的 SES 差异，并可能成为改善所有 T1D 儿童获取途径的模式。
