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

Abstract

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.