Open Access Research article

Disparities in diabetes care: role of the patient's socio-demographic characteristics

Rachel Wilf-Miron12*, Ronit Peled3, Einat Yaari1, Orna Shem-Tov1, Vainer Anna Weinner1, Avi Porath34 and Ehud Kokia24

Author Affiliations

1 Quality Management in Health Care, Maccabi Healthcare Services, Tel-Aviv, Israel

2 Faculty of Management, Tel-Aviv University, Tel-Aviv, Israel

3 Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel

4 Central Management, Maccabi Healthcare Services, Tel-Aviv, Israel

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BMC Public Health 2010, 10:729  doi:10.1186/1471-2458-10-729

Published: 25 November 2010

Abstract

Background

The commitment to promoting equity in health is derived from the notion that all human beings have the right to the best attainable health. However, disparities in health care are well-documented. The objectives were to explore disparities in diabetes prevalence, care and control among diabetic patients. The study was conducted by Maccabi Healthcare Services (MHS), an Israeli HMO (health care plan).

Methods

Retrospective study. The dependent variables were diabetes prevalence, uptake of follow-up examinations, and disease control. The independent variables were socio-economic rank (SER), ethnicity (Arab vs non Arab), supplementary voluntary health insurance (SVHI), and immigration from Former Soviet Union (FSU) countries. Chi Square and Logistic Regression Models were estimated.

Results

We analyzed 74,953 diabetes patients. Diabetes was more prevalent in males, lower SER patients, Arabs, immigrants and owners of SVHI. Optimal follow up was more frequent among females, lower SERs patients, non Arabs, immigrants and SVHI owners. Patients who were female, had higher SERs, non Arabs, immigrants and SVHI owners achieved better control of the disease. The multivariate analysis revealed significant associations between optimal follow up and age, gender (males), SER (Ranks 1-10), Arabs and SVHI (OR 1.02, 0.95, 1.15, 0.85 and 1.31, respectively); poor diabetes control (HbA1C > 9 gr%) was significantly associated with age, gender (males), Arabs, immigrants, SER (Ranks1-10) and SVHI (OR 0.96, 1.26, 1.38, 0.72, 1.37 and 0.57, respectively); significant associations with LDL control (< 100 gr%) were revealed for age, gender (males) and SVHI (OR 1.02, 1.30 and 1.44, respectively).

Conclusion

Disparities in diabetes prevalence, care and control were revealed according to population sub-group. MHS has recently established a comprehensive strategy and action plan, aimed to reduce disparities among members of low socioeconomic rank and Arab ethnicity, sub-groups identified in our study as being at risk for less favorable health outcomes.