Diabetologist, Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland District Health Board, New Zealand.
Biostatistician, Department of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand.
N Z Med J. 2022 Nov 11;135(1565):74-82. doi: 10.26635/6965.5830.
Lower socio-economic status (SES) is linked to greater morbidity in people with young-onset type 2 (T2D) and type 1 diabetes (T1D). We assessed healthcare utilisation from this population and the impact of SES.
Retrospective analysis of 1,350 people with T2D and 731 with T1D diagnosed between 15-30 years of age referred to secondary diabetes services in Auckland, New Zealand. Primary care visits, referral to/attendance at diabetes clinics, and hospital admissions were recorded; their relationship to a validated national index of deprivation (NZDep) was assessed.
The proportion with primary care attendance was similar in both groups with no significant variation with NZDep. For T2D, NZDep was a predictor of delayed referral (≧1-year post-diagnosis) to diabetes services, following adjustment for age and HbA1c in the year of diagnosis (OR 1.15 for every decile increase in NZDep, 95% CI 1.07-1.24, p=0.0003). The median number of appointments offered over a 2-year period was greater for T1D (2.0 (IQR 0, 7) vs (0 (IQR 0, 2), p<0.001); non-attendance increased with NZDep for T2D (p=0.016). The proportion with hospital admissions was similar in both groups and increased with NZDep (T1D p<0.001, T2D p=0.015).
SES impacts several measures of healthcare utilisation. Current healthcare models are inadequately servicing people with young-onset T2D.
较低的社会经济地位（SES）与年轻起病的 2 型糖尿病（T2D）和 1 型糖尿病（T1D）患者的发病率较高有关。我们评估了该人群的医疗保健利用情况及其 SES 的影响。
对在新西兰奥克兰二级糖尿病服务机构确诊为 15-30 岁的 1350 例 T2D 患者和 731 例 T1D 患者进行回顾性分析。记录初级保健就诊、转诊/就诊糖尿病诊所和住院情况；评估与验证的全国贫困指数（NZDep）的关系。
两组患者的初级保健就诊比例相似，与 NZDep 无显著差异。对于 T2D，NZDep 是糖尿病服务延迟转诊（≧诊断后 1 年）的预测因素，调整诊断当年的年龄和 HbA1c 后（每增加一个 NZDep 十分位数，OR 1.15，95%CI 1.07-1.24，p=0.0003）。在 2 年期间提供的预约中位数在 T1D 中更高（2.0（IQR 0，7）比（0（IQR 0，2），p<0.001）；T2D 中随着 NZDep 的增加，非就诊率增加（p=0.016）。两组患者的住院比例相似，且随着 NZDep 的增加而增加（T1D <0.001，T2D p=0.015）。
SES 影响医疗保健利用的几个措施。目前的医疗保健模式未能充分满足年轻起病的 T2D 患者的需求。
