You are here

  • Home
  • Archive
  • Volume 8, Issue 1
  • Effect of socioeconomic deprivation on outcomes of diabetes complications in patients with type 2 diabetes mellitus: a nationwide population-based cohort study of South Korea

Article Text

Article menu

Download PDFPDF

XML
Epidemiology/Health Services Research
Effect of socioeconomic deprivation on outcomes of diabetes complications in patients with type 2 diabetes mellitus: a nationwide population-based cohort study of South Korea
  1. Dong-Woo Choi1,
  2. Sang Ah Lee2,
  3. Doo Woong Lee1,
  4. Jae Hong Joo1,
  5. Kyu-Tae Han3,
  6. SeungJu Kim4,
  7. Eun-Cheol Park5
  1. 1Department of Public Health, Graduate School, Yonsei University, Seoul, Korea (the Republic of)
  2. 2Research and Analysis Team, National Health Insurance Corporation Ilsan Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  3. 3Division of Cancer Management Policy, National Cancer Center, Goyang, Gyeonggi-do, Korea (the Republic of)
  4. 4Department of Nursing, Eulji University, Seongnam, Gyeonggi-do, Korea (the Republic of)
  5. 5Department Preventive Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
  1. Correspondence to Professor Eun-Cheol Park; ecpark{at}yuhs.ac

Abstract

Introduction This study aimed to examine the effect of socioeconomic deprivation on the outcomes of diabetes complications in patients with type 2 diabetes mellitus (T2DM).

Research design and methods We conducted a cohort study using claims data and 2005 national census data. We included of 7510 patients newly diagnosed with T2DM from 2004 to 2012 and aged 40 years or above. We excluded participants who had onset of diabetes complications and hospitalization within 1 year after initial onset T2DM, aged less than 40 years and with missing covariates. We used the regional socioeconomic deprivation index and classified study participants into five categories according to the quintile distribution. We calculated the adjusted HR and 95% CI for hospitalization related to diabetes complications and all-cause mortality by applying Cox proportional hazards model and the adjusted subdistribution hazards model.

Results The percentages of participants in the first quintile (least deprived) to fifth quintile (most deprived) were 27.0%, 27.9%, 19.5%, 14.8%, and 10.8% for socioeconomic deprivation; 25.4%, 28.8%, 32.4%, 34.6%, and 37.6% for hospitalization due to diabetes complications; 1.3%, 2.1%, 2.5%, 2.9%, and 3.6% for deaths from diabetes complications; and 5.7%, 7.2%, 9.7%, 9.7%, and 13.1% for deaths from all causes, respectively. Participants with higher socioeconomic deprivation had a higher HR for hospitalization and mortality from all-cause and diabetes complications. These associations were the strongest among men and participants in their 40s in hospitalization related to diabetes complications, 50s in diabetes complications-specific mortality and 50s and 60s in all-cause mortality.

Conclusions Patients with T2DM with high socioeconomic deprivation had higher hospital admission and mortality rates for diabetes complications than those with low deprivation. We cannot fully explain the effect of socioeconomic deprivation on diabetes outcomes. Therefore, further studies are needed in order to find underlying mechanisms for these associations.

  • socioeconomic deprivation
  • type 2 diabetes
  • mortality
  • complication(s)
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2019-000729

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors D-WC conducted the design of the study, interpretation of data, and writing of the initial manuscript. D-WC, SAL and DWL conducted analysis of the data. JHJ, K-TH and SK reviewed the manuscript. E-CP is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors reviewed, contributed to, and approved the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval was obtained from the Institutional Review Board of Eulji University (Approval number: EU19-13).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. The data can be accessed on the National Health Insurance Data Sharing Service homepage of the National Health Insurance Service (http://nhiss.nhis.or.kr). Applications to use the NHIS data will be reviewed by the inquiry committee of research support and, once approved, raw data will be provided to the applicant with a fee.