Funakoshi Mitsuhiko, Nishioka Daisuke, Haruguchi Seiji, Yonemura Sakae, Takebe Takashi, Nonaka Misato, Iwashita Sanae
Department of Preventive Medicine, Chidoribashi Hospital, Fukuoka, Japan.
Kyushu Institute for Social Medicine, Kitakyushu, Japan.
BMJ Public Health. 2024 May 30;2(1):e000686. doi: 10.1136/bmjph-2023-000686. eCollection 2024 Jun.
Previous research has highlighted the association between socioeconomic factors and diabetes management. This study aimed to elucidate the blood glucose control status among individuals with low income (ie, recipients of public assistance (PARs) and free/low-cost medical care (FLCMC) programme beneficiaries) and to investigate the effects of public subsidies for medical expenses on treatment adherence among low-income patients with diabetes.
We conducted a secondary analysis of medical records from 910 outpatients with diabetes who underwent pharmacological treatment for >90 days. Data on predictive variables, such as glycated haemoglobin (HbA1c) level and control variables, including sex, age and insurance type, were obtained retrospectively. The HbA1c levels among public health insurance (PHI)-only beneficiaries, FLCMC programme beneficiaries and PARs were compared using logistic regression analysis.
The analysis included 874 individuals, among whom the majority were men (61.7%) and aged≥65 years (58.4%). Logistic regression analysis revealed that among individuals aged ˂65 years, the adjusted ORs for HbA1c levels above 9% were significantly higher in FLCMC programme beneficiaries (OR=5.37, 95% CI: 2.23 to 12.82) and PARs (OR=5.97, 95% CI: 2.91 to 12.74) than in PHI-only beneficiaries. Among patients aged ˂65 years with HbA1c levels above 7%, the adjusted OR was significantly higher in FLCMC programme beneficiaries (OR=3.82, 95% CI: 1.65 to 10.43) than in PHI-only beneficiaries. Additionally, the adjusted OR was significantly higher in FLCMC programme beneficiaries aged ˂65 years (OR=2.57, 95% CI: 1.02 to 7.44) than in PARs.
This study highlights the predictive value of public assistance or the FLCMC programme for poor blood glucose control and suggests the inadequacy of current medical expense subsidies to eliminate health disparities in diabetes control.
先前的研究强调了社会经济因素与糖尿病管理之间的关联。本研究旨在阐明低收入个体（即公共援助接受者（PARs）和免费/低成本医疗护理（FLCMC）项目受益者）的血糖控制状况，并调查医疗费用公共补贴对低收入糖尿病患者治疗依从性的影响。
我们对910例接受药物治疗超过90天的糖尿病门诊患者的病历进行了二次分析。回顾性获取预测变量数据，如糖化血红蛋白（HbA1c）水平，以及控制变量，包括性别、年龄和保险类型。使用逻辑回归分析比较仅参加公共医疗保险（PHI）者、FLCMC项目受益者和PARs的HbA1c水平。
分析纳入874人，其中大多数为男性（61.7%）且年龄≥65岁（58.4%）。逻辑回归分析显示，在年龄<65岁的个体中，FLCMC项目受益者（OR=5.37，95%CI：2.23至12.82）和PARs（OR=5.97，95%CI：2.91至12.74）中糖化血红蛋白水平高于9%的校正OR显著高于仅参加公共医疗保险者。在年龄<65岁且糖化血红蛋白水平高于7%的患者中，FLCMC项目受益者的校正OR（OR=3.82，95%CI：1.65至10.43）显著高于仅参加公共医疗保险者。此外，年龄<65岁的FLCMC项目受益者的校正OR（OR=2.57，95%CI：1.02至7.44）显著高于PARs。
本研究突出了公共援助或FLCMC项目对血糖控制不佳的预测价值，并表明当前医疗费用补贴不足以消除糖尿病控制方面的健康差异。
