Health Policy Manag.  2021 Mar;31(1):114-124. 10.4332/KJHPA.2021.31.1.114.

Interaction Effects between Individual Socioeconomic Status and Regional Deprivation on Onset of Diabetes Complication and Diabetes-Related Hospitalization among Type 2 Diabetes Patients: National Health Insurance Cohort Sample Data from 2002 to 2013

Affiliations
  • 1Graduate Program of Industrial Pharmaceutical Science, College of Pharmacy, Yonsei University, Seoul, Korea
  • 2Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
  • 3Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
  • 4Research and Analysis Team, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
  • 5Fetal Alcohol Syndrome Prevention Center, Ewha Womans University Mokdong Hospital, Seoul, Korea
  • 6Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea

Abstract

Background
In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.
Methods
Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: ‘high in advantaged,’ ‘high in disadvantaged,’ ‘middle in advantaged,’ ‘middle in disadvantaged,’ ‘low in advantaged,’ and ‘low in disadvantaged.’ We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions.
Results
In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00–1.08) compared to the ‘low in disadvantaged’ group (HR, 1.10; 95% CI, 1.05–1.16). In addition, the ‘high in advantaged’ group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00–1.11) compared to the ‘low in advantaged’ and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19–1.41) compared to the other groups.
Conclusion
Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.

Keyword

Diabetes mellitus; Diabetes complications; Regional deprivation; Diabetes-related hospitalization
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