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. 2010 Jan 12;182(1):E1-E17.
doi: 10.1503/cmaj.090495. Epub 2009 Dec 21.

Income-related differences in mortality among people with diabetes mellitus

Lorraine L Lipscombe  1 , Peter C Austin, Douglas G Manuel, Baiju R Shah, Janet E Hux, Gillian L Booth
Affiliations

Income-related differences in mortality among people with diabetes mellitus

Lorraine L Lipscombe et al. CMAJ. .

Abstract

Background: Mortality has declined substantially among people with diabetes mellitus over the last decade. Whether all income groups have benefited equally, however, is unclear. We examined the impact of income on mortality trends among people with diabetes.

Methods: In this population-based, retrospective cohort study, we compared changes in mortality from Apr. 1, 1994, to Mar. 31, 2005, by neighbourhood income strata among people with diabetes aged 30 years or more in the province of Ontario, Canada.

Results: Overall, the annual age- and sex-adjusted mortality declined, from 4.05% in 1994/95 (95% confidence interval [CI] 3.98%-4.11%) to 2.69% in 2005/06 (95% CI 2.66%-2.73%). The decrease was significantly greater in the highest income group (by 36%) than in the lowest income group (by 31%; p < 0.001). This trend was most pronounced in the younger group (age 30-64 years): the mortality rate ratio widened by more than 40% between the lowest and highest income groups, from 1.12 to 1.59 among women and from 1.14 to 1.60 among men. Income had a much smaller effect on mortality trends in the older group, whose drug costs are subsidized: the income-related difference rose by only 0.9% over the study period.

Interpretation: Mortality declined overall among people with diabetes from 1994 to 2005; however, the decrease was substantially greater in the highest income group than in the lowest, particularly among those aged 30-64 years. These findings illustrate the increasing impact of income on the health of people with diabetes even in a publicly funded health care setting. Further studies are needed to explore factors responsible for these income-related differences in mortality.

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Figures

Figure 1
Figure 1
Age- and sex-standardized mortality by income quintile among people in Ontario aged 30 years or more with diabetes mellitus from 1994/95 to 2005/06.
Figure 2
Figure 2
Predicted mortality by income quintile among women with diabetes aged 30–64 years (top panel) and women aged 65 or more (bottom panel) from 1994/95 to 2005/06. (Trends were similar among men.)
Figure 3
Figure 3
Mortality rate ratios between the lowest and highest income quintile among women and men aged 30 years or more with diabetes from 1994/95 to 2005/06.
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