National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China.
Front Public Health. 2022 Sep 16;10:956883. doi: 10.3389/fpubh.2022.956883. eCollection 2022.
Globally, diabetes and its complications are becoming one of the leading challenges in health governance. As health inequalities and primary care services related to diabetes are gaining traction, the status of community-based diabetes examination largely remains unclear in the literature. This study aims to investigate inequalities in access to community-based diabetes examination among people with diabetes and to analyze its impact on healthcare utilization. Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were applied, and a total of 767 patients with diabetes were included. Inequalities in community-based diabetes examination were illustrated by the concentration curve and normalized concentration index. Propensity score matching (PSM) were used to identify the impact of community-based diabetes examination on outpatient and inpatient care utilization. We found that community-based diabetes examination was accessible to 23.08% of the respondents, of which 76.84% were free, and the highest frequency was 2-6 times per year, accounting for 47.46%. Community-based diabetes examinations were more concentrated among people with poorer-economic condition (95% confidence interval, 95%CI = -0.104, = 0.0035), lower-education level (95%CI = -0.092, = 0.0129), and less-developed areas (95%CI = -0.103, = 0.0007). PSM analyses showed that community-based diabetes examination increased the utilization of outpatient care (odds ratio, OR = 1.989, 95%CI = 1.156-3.974) and decreased the use of inpatient care (OR = 0.544, 95%CI = 0.325-0.909), and the sensitivity analyses confirmed the robustness of the results. This study is the first to examine the status and inequalities of community-based regular diabetes examination and its effect on the likelihood of healthcare utilization among patients with diabetes. The findings suggest that the overall level of community-based diabetes examination is low, and there are pro-socioeconomically disadvantaged inequalities. The value of community-based diabetes examination should be recognized to help person with diabetes face up to their health needs for better disease control and health promotion.
在全球范围内，糖尿病及其并发症正成为健康治理面临的主要挑战之一。随着健康不平等和与糖尿病相关的初级保健服务日益受到关注，社区为基础的糖尿病检查的现状在文献中尚不清楚。本研究旨在调查糖尿病患者获得社区为基础的糖尿病检查的机会不平等情况，并分析其对医疗保健利用的影响。本研究使用了 2018 年中国健康与养老追踪调查（CHARLS）的数据，共纳入 767 名糖尿病患者。使用集中曲线和标准化集中指数来展示社区为基础的糖尿病检查的不平等情况。采用倾向评分匹配（PSM）来确定社区为基础的糖尿病检查对门诊和住院治疗利用的影响。我们发现，有 23.08%的受访者可以进行社区为基础的糖尿病检查，其中 76.84%是免费的，最高频率为每年 2-6 次，占 47.46%。社区为基础的糖尿病检查更多地集中在经济条件较差（95%置信区间，95%CI = -0.104， = 0.0035）、教育程度较低（95%CI = -0.092， = 0.0129）和欠发达地区（95%CI = -0.103， = 0.0007）的人群中。PSM 分析表明，社区为基础的糖尿病检查增加了门诊治疗的利用率（优势比，OR = 1.989，95%CI = 1.156-3.974），减少了住院治疗的利用率（OR = 0.544，95%CI = 0.325-0.909），敏感性分析结果证实了结果的稳健性。本研究首次考察了糖尿病患者社区定期糖尿病检查的现状和不平等情况及其对医疗保健利用的影响。研究结果表明，社区为基础的糖尿病检查的总体水平较低，且存在有利于社会经济地位较低人群的不平等现象。应该认识到社区为基础的糖尿病检查的价值，以帮助糖尿病患者认识到他们的健康需求，从而更好地控制疾病并促进健康。
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