Death Rates Higher for Low-Income Diabetics
Reported December 22, 2009
(Ivanhoe Newswire) — While mortality from diabetes has declined in Canada, the income-related mortality gap is increasing, with lower income groups faring worse than higher income groups.
Globally, diabetes is associated with a two-fold increase in mortality, with most of those deaths due to cardiovascular issues. Survival for people with diabetes has improved over the last 10 years, partly because of better diabetes care and a reduction in cardiovascular events.
The number of people in Ontario, aged 30 or older, with diabetes rose 130 percent from 1995 to 2006, while the non-diabetes population rose 17 percent over the same period. Death rates were significantly higher in men than in women and in people aged 65 and older.
Age- and sex-standardized mortality fell by 33 percent across all income groups, but the higher income groups experienced a larger decline in mortality than the lowest income group. In people aged 30 to 64, there was a more than 40 percent widening in the rate ratio between the poorest versus the richest group.
“Our findings suggest that improvements in diabetes outcomes may be lagging in the poorer segments of the diabetic population,” Dr. Lorraine Lipscombe of Women’s College Hospital in Toronto and coauthors were quoted as saying.
They suggest several reasons. Increasing costs of medications may be limiting access and compromising care for people who cannot afford them. In people aged 65 and over, income had a much smaller effect on mortality, as drug costs are subsidized for this age group. Lower health literacy in poorer patients may be hindering their ability to follow complicated medical routines.
Changing demographics in Ontario, especially due to immigration, may also be a factor. Between 1996 and 2006, 37 percent of immigrants were South Asian, a group susceptible to diabetes and cardiovascular complications. New immigrants often have lower incomes.
The authors concluded, “Our study highlights the urgent need to address barriers to adequate diabetes care in low-income populations, to stem the rising burden of diabetes among poorer people.”
SOURCE: Canadian Medical Association Journal (CMAJ), December 21, 2009