TY - JOUR
T1 - Trends and socioeconomic disparities in diabetes prevalence and quality of care among Israeli children; 2011-2018
AU - Loewenberg Weisband, Yiska
AU - Krieger, Michal
AU - Calderon-Margalit, Ronit
AU - Manor, Orly
N1 - Publisher Copyright:
© 2020 The Author(s).
PY - 2020/8/20
Y1 - 2020/8/20
N2 - Background: Despite Israel's universal health coverage, disparities in health services provision may still exist. We aimed to assess socioeconomic disparities in diabetes prevalence and quality of care among Israeli children, and to assess whether these changed over time. Methods: We used repeated cross-sectional analyses in the setting of the National Program for Quality Indicators in Community Healthcare. The data were derived from electronic medical records from Israel's four health maintenance organizations. The study population included all Israeli children aged 2-17 years in 2011-2018 (2018: N = 2,404,856). Socio-economic position (SEP) was measured using Central Bureau of Statistics data further updated by a private company (Points Business Mapping Ltd), and grouped into 4 categories, ranging from 1 (lowest) to 4 (highest). We used logistic regression to assess the association of SEP with diabetes prevalence, diabetes clinic visits, hemoglobin A1C (HbA1C) testing, and poor glycemic control (HbA1c > 9%), and assessed whether these changed over time. Results: Diabetes prevalence increased with age and SEP, with a total of 3019 children with diabetes. SEP was positively associated with visiting a specialized diabetes clinic (age and sex adjusted Odds Ratio (aORSEP 4 vs. 1 2.45, 95% Confidence Interval (CI) 1.67-3.69)). Although children in higher SEPs were less likely to undergo HbA1c testing (aORSEP 4 vs. 1 0.54, 95% CI 0.40-0.72), they were also less likely to have poor glycemic control (aORSEP 4 vs. 1 0.25, 95% CI 0.18-0.34). Disparities were especially apparent among children aged 2-9 (6.5% poor glycemic control in SEP 4 vs. 38.2% in SEP 1). Poor glycemic control decreased over time, from 44.0% in 2011 to 34.1% in 2018. Conclusions: While poor glycemic control rates among children have improved, they remain high compared to rates in adults. Additionally, substantial socioeconomic gaps remain. It is eminent to study the causes of these disparities and develop policies to improve care provided to children in the lower SEP levels, to promote health equity.
AB - Background: Despite Israel's universal health coverage, disparities in health services provision may still exist. We aimed to assess socioeconomic disparities in diabetes prevalence and quality of care among Israeli children, and to assess whether these changed over time. Methods: We used repeated cross-sectional analyses in the setting of the National Program for Quality Indicators in Community Healthcare. The data were derived from electronic medical records from Israel's four health maintenance organizations. The study population included all Israeli children aged 2-17 years in 2011-2018 (2018: N = 2,404,856). Socio-economic position (SEP) was measured using Central Bureau of Statistics data further updated by a private company (Points Business Mapping Ltd), and grouped into 4 categories, ranging from 1 (lowest) to 4 (highest). We used logistic regression to assess the association of SEP with diabetes prevalence, diabetes clinic visits, hemoglobin A1C (HbA1C) testing, and poor glycemic control (HbA1c > 9%), and assessed whether these changed over time. Results: Diabetes prevalence increased with age and SEP, with a total of 3019 children with diabetes. SEP was positively associated with visiting a specialized diabetes clinic (age and sex adjusted Odds Ratio (aORSEP 4 vs. 1 2.45, 95% Confidence Interval (CI) 1.67-3.69)). Although children in higher SEPs were less likely to undergo HbA1c testing (aORSEP 4 vs. 1 0.54, 95% CI 0.40-0.72), they were also less likely to have poor glycemic control (aORSEP 4 vs. 1 0.25, 95% CI 0.18-0.34). Disparities were especially apparent among children aged 2-9 (6.5% poor glycemic control in SEP 4 vs. 38.2% in SEP 1). Poor glycemic control decreased over time, from 44.0% in 2011 to 34.1% in 2018. Conclusions: While poor glycemic control rates among children have improved, they remain high compared to rates in adults. Additionally, substantial socioeconomic gaps remain. It is eminent to study the causes of these disparities and develop policies to improve care provided to children in the lower SEP levels, to promote health equity.
KW - Diabetes prevalence
KW - Pediatric diabetes
KW - Quality of care
KW - Socioeconomic disparities
UR - http://www.scopus.com/inward/record.url?scp=85089769963&partnerID=8YFLogxK
U2 - 10.1186/s13584-020-00399-w
DO - 10.1186/s13584-020-00399-w
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 32819418
AN - SCOPUS:85089769963
SN - 2045-4015
VL - 9
JO - Israel Journal of Health Policy Research
JF - Israel Journal of Health Policy Research
IS - 1
M1 - 41
ER -