Socioeconomic status and diabetes-related hospital admissions: a cross-sectional study of people with diagnosed diabetes.

BACKGROUND

Low socioeconomic status (SES) is associated with adverse cardiovascular risk factor patterns and poorer outcomes for people with diabetes.

METHODS

A cross-sectional study was performed using data for 35,925 people with diagnosed diabetes in Scotland and an area-based measure of SES using linked hospital and population-based diabetes register records. Comparisons by quintile of SES were made before (with p values presented for trend across quintiles given below) and after adjusting for other factors using multivariable logistic regression.

RESULTS

People in the most deprived quintile were more likely than people in the most affluent quintile to have hospital records for diabetic kidney disease (2.4% vs 2.0%, p=0.049), diabetic ketoacidosis (3.5% vs 3.0%, p=0.11), hypoglycaemia (1.8% vs 1.4%, p=0.008), ischaemic heart disease (22% vs 17%, p<0.0001), stroke (6.8% vs 5.1%, p<0.0001) and peripheral arterial disease (4.1% vs 2.1%, p<0.0001). An independent effect of SES persisted for cardiovascular disease outcomes after adjusting for age and sex. There were minimal differences in disease management measures by SES.

CONCLUSION

Managing current risk factors equitably is unlikely to remove socioeconomic inequalities in diabetes-related outcomes. Measures of SES may be valuable in risk scores and in making valid comparisons of the quality of diabetes care.