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The usefulness of small-area-based socioeconomic characteristics in assessing the treatment outcomes of type 2 diabetes patients: a register-based mixed-effect study
BACKGROUND: Assessment of the differences in the outcomes of care by socioeconomic status (SES) is beneficial for both the efficient targeting of health care services and to decrease health inequalities. This study compares the effects of three patient-based SES predictors (earned income, educationa...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236994/ https://www.ncbi.nlm.nih.gov/pubmed/30428885 http://dx.doi.org/10.1186/s12889-018-6165-3 |
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author | Toivakka, Maija Pihlapuro, Aki Tykkyläinen, Markku Mehtätalo, Lauri Laatikainen, Tiina |
author_facet | Toivakka, Maija Pihlapuro, Aki Tykkyläinen, Markku Mehtätalo, Lauri Laatikainen, Tiina |
author_sort | Toivakka, Maija |
collection | PubMed |
description | BACKGROUND: Assessment of the differences in the outcomes of care by socioeconomic status (SES) is beneficial for both the efficient targeting of health care services and to decrease health inequalities. This study compares the effects of three patient-based SES predictors (earned income, educational attainment, employment status) with three small-area-based SES predictors (median income, educational attainment, proportion of the unemployed) on the treatment outcomes of type 2 diabetes patients. METHODS: Mixed-effect modeling was applied to analyse how SES factors affect the treatment outcomes of type 2 diabetes patients. The treatment outcomes were assessed by the patients’ latest available glycated hemoglobin A(1C) (HbA1c) value. We used electronic health records of type 2 diabetes patients from the regional electronic patient database, the patients’ individual register-based SES information from Statistics Finland, and the SES information about the population of the postal code area of the patients from Statistics Finland. RESULTS: The effects of attained education on the treatment outcomes, both at the patient-level and the small-area-level are quite similar. Age and male gender were associated with higher HbA1c values and lower education indicated higher HbA1c values. Unemployment was not associated with HbA1c values at either the patient-level or the area-level. Income gave divergent results: high values of HbA1c were associated with low patient incomes but the median income of the postal code area did not predict the treatment outcomes of patients. CONCLUSIONS: Our comparative study of three SES factors shows that the effects of attained education on the treatment outcomes are rather similar, regardless of whether patient-based or small-area-based predictors are used. Small-area-based SES variables can be a good way to overcome the absence of individual SES information, but further research is needed to find the valid small-area factors by disease. This possibility of using more small-area-based data would be valuable in health service research and first-hand planning of health care services. |
format | Online Article Text |
id | pubmed-6236994 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-62369942018-11-23 The usefulness of small-area-based socioeconomic characteristics in assessing the treatment outcomes of type 2 diabetes patients: a register-based mixed-effect study Toivakka, Maija Pihlapuro, Aki Tykkyläinen, Markku Mehtätalo, Lauri Laatikainen, Tiina BMC Public Health Research Article BACKGROUND: Assessment of the differences in the outcomes of care by socioeconomic status (SES) is beneficial for both the efficient targeting of health care services and to decrease health inequalities. This study compares the effects of three patient-based SES predictors (earned income, educational attainment, employment status) with three small-area-based SES predictors (median income, educational attainment, proportion of the unemployed) on the treatment outcomes of type 2 diabetes patients. METHODS: Mixed-effect modeling was applied to analyse how SES factors affect the treatment outcomes of type 2 diabetes patients. The treatment outcomes were assessed by the patients’ latest available glycated hemoglobin A(1C) (HbA1c) value. We used electronic health records of type 2 diabetes patients from the regional electronic patient database, the patients’ individual register-based SES information from Statistics Finland, and the SES information about the population of the postal code area of the patients from Statistics Finland. RESULTS: The effects of attained education on the treatment outcomes, both at the patient-level and the small-area-level are quite similar. Age and male gender were associated with higher HbA1c values and lower education indicated higher HbA1c values. Unemployment was not associated with HbA1c values at either the patient-level or the area-level. Income gave divergent results: high values of HbA1c were associated with low patient incomes but the median income of the postal code area did not predict the treatment outcomes of patients. CONCLUSIONS: Our comparative study of three SES factors shows that the effects of attained education on the treatment outcomes are rather similar, regardless of whether patient-based or small-area-based predictors are used. Small-area-based SES variables can be a good way to overcome the absence of individual SES information, but further research is needed to find the valid small-area factors by disease. This possibility of using more small-area-based data would be valuable in health service research and first-hand planning of health care services. BioMed Central 2018-11-14 /pmc/articles/PMC6236994/ /pubmed/30428885 http://dx.doi.org/10.1186/s12889-018-6165-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Toivakka, Maija Pihlapuro, Aki Tykkyläinen, Markku Mehtätalo, Lauri Laatikainen, Tiina The usefulness of small-area-based socioeconomic characteristics in assessing the treatment outcomes of type 2 diabetes patients: a register-based mixed-effect study |
title | The usefulness of small-area-based socioeconomic characteristics in assessing the treatment outcomes of type 2 diabetes patients: a register-based mixed-effect study |
title_full | The usefulness of small-area-based socioeconomic characteristics in assessing the treatment outcomes of type 2 diabetes patients: a register-based mixed-effect study |
title_fullStr | The usefulness of small-area-based socioeconomic characteristics in assessing the treatment outcomes of type 2 diabetes patients: a register-based mixed-effect study |
title_full_unstemmed | The usefulness of small-area-based socioeconomic characteristics in assessing the treatment outcomes of type 2 diabetes patients: a register-based mixed-effect study |
title_short | The usefulness of small-area-based socioeconomic characteristics in assessing the treatment outcomes of type 2 diabetes patients: a register-based mixed-effect study |
title_sort | usefulness of small-area-based socioeconomic characteristics in assessing the treatment outcomes of type 2 diabetes patients: a register-based mixed-effect study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236994/ https://www.ncbi.nlm.nih.gov/pubmed/30428885 http://dx.doi.org/10.1186/s12889-018-6165-3 |
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