New research shows that mortality is strongly associated with the socioeconomic status of patients with type 2 diabetes. It also found that where you live has an impact on how likely you are to be readmitted to hospital following hospital discharge if you have type 1 diabetes.
The study was presented at the European Association for the Study of Diabetes by Dr Tim Robbins, Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK, and colleagues from both the University of Warwick and University Hospitals Coventry & Warwickshire NHS Trust, UK.
It was based on a retrospective evaluation of data from the electronic health records of a large UK specialist referral centre (University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK) and included all adult patients discharged with a diabetes diagnosis over a three-year period. These comprised 46,357 distinct discharges and were matched at a patient level with postcode sector socioeconomic data extracted from the Office of National Statistics Census and Population Density datasets.
Information on 19 socioeconomic variables was available including index of multiple deprivation, employment status, ethnicity, activity levels, unpaid care provision, and density of population and housing, which could then be used to determine the socioeconomic status of each patient. The clinical outcome measures chosen were readmission within 28 days, and incidence of mortality within 180 days (approximately six months) of discharge from hospital.
Type 2 diabetes and mortality risk
The authors found that socioeconomic status measured by 14 of the 19 variables was significantly associated with 180-day mortality in the type 2 diabetes patient cohort, while in the type 1 diabetes cohort they found no statistically significant association between mortality and socioeconomic variables. Among type 2 diabetes patients, the strongest links with mortality were found to be language (non-English), ethnicity (ethnic minorities), and index of multiple deprivation.
For hospital readmissions, only one of the 19 variables showed a significant association in type 2 diabetes patients, compared to nine statistically significant variables in the type 1 diabetes group, with the strongest being deprivation indices and health-related activity impairment.
The authors say: "There is a strong association between geographic socioeconomic status and readmission to hospital in patients with type 1 diabetes, but no clear link with mortality. In contrast in patients with type 2 diabetes, mortality is strongly associated with socioeconomic status whilst readmission to hospital is not. In summary, where you live has an impact on how likely you are to be readmitted to hospital for patients with type 1 diabetes, and how likely you are to die for patients with type 2 diabetes following hospital discharge.
"Use of geographic postcode sector data can be readily incorporated into electronic healthcare systems and future risk models to enable personalised data-driven care, for example more intensive, or different models, or more intensive follow up for those from areas of known deprivation."