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Diabetes Care. 2012 Nov;35(11):2257-64. doi: 10.2337/dc12-0364. Epub 2012 Aug 13.

Universal drug coverage and socioeconomic disparities in major diabetes outcomes.

Author information

  • 1Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada. boothg@smh.ca

Abstract

OBJECTIVE:

Due in large part to effective pharmacotherapy, mortality rates have fallen substantially among those with diabetes; however, trends have been less favorable among those of lower socioeconomic status (SES), leading to a widening gap in mortality between rich and poor. We examined whether income disparities in diabetes-related morbidity or mortality decline after age 65 in a setting where much of health care is publicly funded yet universal drug coverage starts only at age 65.

RESEARCH DESIGN AND METHODS:

We conducted a population-based retrospective cohort study using administrative health claims from Ontario, Canada. Adults with diabetes (N = 606,051) were followed from 1 April 2002 to 31 March 2008 for a composite outcome of death, nonfatal acute myocardial infarction (AMI), and nonfatal stroke. SES was based on neighborhood median household income levels from the 2001 Canadian Census.

RESULTS:

SES was a strong predictor of death, nonfatal AMI, or nonfatal stroke among those <65 years of age (adjusted hazard ratio [HR] 1.51 [95% CI 1.45-1.56]) and exerted a lesser effect among those ≥65 years of age (1.12 [1.09-1.14]; P < 0.0001 for interaction), after adjusting for age, sex, baseline cardiovascular disease (CVD), diabetes duration, comorbidity, and health care utilization. SES gradients were consistent for all groups <65 years of age. Similar findings were noted for 1-year post-AMI mortality (<65 years of age, 1.33 [1.09-1.63]; ≥65 years of age, 1.09 [1.01-1.18]).

CONCLUSIONS:

Observed SES differences in CVD burden diminish substantially after age 65 in our population with diabetes, which may be related to universal access to prescription drugs among seniors.

PMID:
22891257
[PubMed - indexed for MEDLINE]
PMCID:
PMC3476904
Free PMC Article
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