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. 2018 Mar 27;18(1):408.
doi: 10.1186/s12889-018-5269-0.

Socioeconomic inequalities in cardiometabolic control in patients with type 2 diabetes

Berta Ibáñez  1   2   3 , Arkaitz Galbete  4   5 , María José Goñi  3   6 , Luis Forga  3   6 , Laura Arnedo  7 , Felipe Aizpuru  2   8 , Julián Librero  1   2 , Oscar Lecea  9 , Koldo Cambra  2   3   10
Affiliations

Socioeconomic inequalities in cardiometabolic control in patients with type 2 diabetes

Berta Ibáñez et al. BMC Public Health. .

Abstract

Background: The aim of this study was to determine if the achievement of control _targets in patients with type 2 diabetes was associated with personal socioeconomic factors and if these associations were sex-dependent.

Methods: This cross-sectional, population-based study was conducted in Spain. Glycated haemoglobin (HbA1c) level and other clinical parameters were obtained from electronic primary care records (n = 32,638 cases). Socioeconomic status was determined using education level and yearly income. Among patients, having their HbA1c level checked during the previous year was considered as an indirect measure of the process of care, whereas tobacco use and clinical parameters such as HbA1c, low-density lipoprotein cholesterol (LDL-c) and blood pressure (BP) were considered intermediate control outcomes. General linear mixed effect models were used to assess associations.

Results: The achievement of metabolic and cardiovascular control _targets in patients with type 2 diabetes was associated with educational level and income, and socioeconomic gradients differed by sex. The probability of having had an HbA1c test performed in the previous year was higher in patients with lower education levels. Patients in the lowest income and education level categories were less likely to have reached the recommended HbA1c level. Males in the lowest education level categories were less likely to be non-smokers or to have achieved the blood pressure _targets. In contrast, patients within the low income categories had a higher probability of reaching the recommended LDL-c level.

Conclusions: Our results suggest the presence of socioeconomic inequalities in the achievement of cardiovascular and metabolic control that differed in direction and magnitude depending on the measured outcome and sex of the patient. These findings may help health professionals focus on high-risk individuals to decrease health inequalities.

Keywords: Cardiometabolic risk factors; Cardiovascular control; Diabetes care; Diabetes mellitus; Glycated haemoglobin; Metabolic control; Socioeconomic inequalities; Socioeconomic status.

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Conflict of interest statement

Ethics approval and consent to participate

This study, which was observational in design, retrospective in nature; and used data irreversibly anonymized prior to transfer to the research team, was conducted in accordance with the amended Helsinki Declaration, International Guidelines for Ethical Review of Epidemiological Studies and Spanish laws on data protection and patients’ rights. The study protocol was approved by the Ethics Committee of Navarre (Project 67/2013, session on October 30th, 2013).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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