Area-based inequalities and distribution of healthcare resources for managing diabetes in South Korea: a cross-sectional multilevel analysis

OBJECTIVES: We aimed to identify area-based socioeconomic inequalities in diabetes management and to examine whether the distribution of healthcare resources could explain area-based inequalities in diabetes management. DESIGN: Cross-sectional multilevel analysis from national survey data. SETTING AND PARTICIPANTS: Data were derived from the 2018 Korean Community Health Survey. Study subjects included 23 760 participants aged 30 years or older with diabetes diagnosed by a doctor. MAIN OUTCOME MEASURES: The dependent variables were self-reported good glycaemic control, haemoglobin A1c (HbA1c) testing, recognition of the term HbA1c, and diabetic complications testing. Area Deprivation Index was used as an area-based measure of socioeconomic position. Factors related to regional healthcare resources—the coefficient of variation (CV) value of clinics and the number of physicians per 1000—were considered as potential mediating variables in explaining the association between diabetes management and area deprivation. A multilevel logistic regression analysis was used. RESULTS: Compared with the least deprived quintile, the likelihoods of not taking HbA1c tests, not recognising the term HbA1c, and not taking diabetic complication tests in the most deprived quintile were approximately 1.5 times (95% CI 1.25 to 1.80), 2.6 times (95% CI 1.97 to 3.45) and two times (95% CI 1.67 to 2.48) higher, respectively. In the most deprived quintile, CV value of clinics was the highest and the number of doctors was the lowest. Regional healthcare resource factors explained inequalities in managing diabetes by 14%–18%, especially in the most deprived quintile. CONCLUSIONS: The results in this study suggest that socioeconomic inequalities in diabetes management may be explained by regional healthcare resource disparities. Policy interventions for a more even distribution of healthcare resources would likely reduce the magnitude of regional socioeconomic inequalities in diabetes management.