Income-related differences in mortality among people with diabetes mellitus

January 01, 0001

Income-related differences in mortality among people with diabetes mellitus

Mortality has declined substantially among people with diabetes mellitus over the last decade. Whether all income groups have benefited equally, however, is unclear. The researchers from Toronto examined the impact of income on mortality trends among people with diabetes. In this population-based, retrospective cohort study, they compared changes in mortality from April 1, 1994, to March 31, 2005, by neighbourhood income strata among people with diabetes aged 30 years or more in the province of Ontario, Canada.

Overall, the annual age- and sex-adjusted mortality declined, from 4.05% in 1994-95 to 2.69% in 2005-06. The decrease was significantly greater in the highest income group (by 36%) than in the lowest income group (by 31%; significant). This trend was most pronounced in the younger group (age 30-64 years): the mortality rate ratio widened by more than 40% between the lowest and highest income groups, from 1.12 to 1.59 among women and from 1.14 to 1.60 among men. Income had a much smaller effect on mortality trends in the older group, whose drug costs are subsidized: the income-related difference rose by only 0.9% over the study period.

The researchers concluded: "Mortality declined overall among people with diabetes from 1994 to 2005; however, the decrease was substantially greater in the highest income group than in the lowest, particularly among those aged 30-64 years. These findings illustrate the increasing impact of income on the health of people with diabetes even in a publicly funded health care setting. Further studies are needed to explore factors responsible for these income-related differences in mortality."

We talk about a bio-psycho-social approach, but are sometimes unaware of the socioeconomic influences.

For the full abstract, click here.

CMAJ 182 (1): E1-17, January 12, 2010
© 2010 Canadian Medical Association
Income-related differences in mortality among people with diabetes mellitus. Lorraine L. Lipscombe, Peter C. Austin, Douglas G. Manuel et al. Correspondence to Dr. Lorraine Lipscombe:

Category: T. Endocrine/Metabolic/Nutritional. Keywords: income, mortality, diabetes mellitus, population based retrospective cohort study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 16 April 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.