Association between area-level socioeconomic status, accessibility and diabetes-related hospitalisations: a cross-sectional analysis of data from Western Victoria, Australia.

Autor:	Sajjad MA; Faculty of Health, Deakin University, Geelong, Victoria, Australia., Holloway-Kew KL; Faculty of Health, Deakin University, Geelong, Victoria, Australia., Mohebbi M; Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia., Kotowicz MA; Faculty of Health, Deakin University, Geelong, Victoria, Australia.; Department of Medicine -Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.; University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia., de Abreu LLF; Faculty of Health, Deakin University, Geelong, Victoria, Australia., Livingston PM; Faculty of Health, Deakin University, Geelong, Victoria, Australia., Khasraw M; Faculty of Health, Deakin University, Geelong, Victoria, Australia.; The University of Sydney, Sydney, New South Wales, Australia., Hakkennes S; University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia., Dunning TL; School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia., Brumby S; National Centre for Farmer Health, Western District Health Service, Hamilton, Victoria, Australia.; School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia., Page RS; Faculty of Health, Deakin University, Geelong, Victoria, Australia.; University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.; Barwon Centre of Orthopaedic Research and Education (B-CORE), St John of God Hospital and Barwon Health, Geelong, Victoria, Australia., Sutherland AG; Faculty of Health, Deakin University, Geelong, Victoria, Australia.; South West Healthcare, Warrnambool, Victoria, Australia., Venkatesh S; Applied Artificial Intelligence Institute, Deakin University, Geelong, Victoria, Australia., Williams LJ; Faculty of Health, Deakin University, Geelong, Victoria, Australia., Brennan-Olsen SL; Department of Medicine -Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Melbourne, Victoria, Australia., Pasco JA; Faculty of Health, Deakin University, Geelong, Victoria, Australia.; Department of Medicine -Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.; University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2019 May 22; Vol. 9 (5), pp. e026880. Date of Electronic Publication: 2019 May 22.
DOI:	10.1136/bmjopen-2018-026880
Abstrakt:	Objective: Hospitalisation rates for many chronic conditions are higher in socioeconomically disadvantaged and less accessible areas. We aimed to map diabetes hospitalisation rates by local government area (LGA) across Western Victoria, Australia, and investigate their association with socioeconomic status (SES) and accessibility/remoteness. Design: Cross-sectional study METHODS: Data were acquired from the Victorian Admitted Episodes Dataset for all hospitalisations (public and private) with a diagnosis of type 1 or type 2 diabetes mellitus during 2011-2014. Crude and age-standardised hospitalisation rates (per 1000 population per year) were calculated by LGA for men, women and combined data. Associations between accessibility (Accessibility/Remoteness Index of Australia, ARIA), SES (Index of Relative Socioeconomic Advantage and Disadvantage, IRSAD) and diabetes hospitalisation were investigated using Poisson regression analyses. Results: Higher LGA-level accessibility and SES were associated with higher rates of type 1 and type 2 diabetes hospitalisation, overall and for each sex. For type 1 diabetes, higher accessibility (ARIA category) was associated with higher hospitalisation rates (men incidence rate ratio [IRR]=2.14, 95% CI 1.64 to 2.80; women IRR=2.45, 95% CI 1.87 to 3.19; combined IRR=2.30, 95% CI 1.69 to 3.13; all p<0.05). Higher socioeconomic advantage (IRSAD decile) was also associated with higher hospitalisation rates (men IRR=1.25, 95% CI 1.09 to 1.43; women IRR=1.32, 95% CI 1.16 to 1.51; combined IRR=1.23, 95% CI 1.07 to 1.42; all p<0.05). Similarly, for type 2 diabetes, higher accessibility (ARIA category) was associated with higher hospitalisation rates (men IRR=2.49, 95% CI 1.81 to 3.43; women IRR=2.34, 95% CI 1.69 to 3.25; combined IRR=2.32, 95% CI 1.66 to 3.25; all p<0.05) and higher socioeconomic advantage (IRSAD decile) was also associated with higher hospitalisation rates (men IRR=1.15, 95% CI 1.02 to 1.30; women IRR=1.14, 95% CI 1.01 to 1.28; combined IRR=1.13, 95% CI 1.00 to 1.27; all p<0.05). Conclusion: Our observations could indicate self-motivated treatment seeking, and better specialist and hospital services availability in the advantaged and accessible areas in the study region. The determinants for such variations in hospitalisation rates, however, are multifaceted and warrant further research. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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