Socioeconomic disparities in preventable hospitalization among adults with diabetes in Taiwan: A multilevel modeling approach

Conduct a longitudinal study, using hierarchical modeling, to evaluate the role of socioeconomic position at both the individual and the regional level regarding the disparities of preventable hospitalizations of diabetes patients in Taiwan.

The database of the National Health Insurance was used in this study. All diabetes patients aged 18 and older who received regular care in 2000 were included in this study. The focus of this study was diabetic–associated preventable hospitalizations in 2001. Socioeconomic status was measured by income at the individual level and the regional level by the proportion of residents that had received a higher education. The control variables included age, gender, comorbidities, and the characteristics of the regular source of care where the patients received their care, including level (i.e. medical center, regional hospital, local hospital, outpatient clinic) and ownership (i.e. public or private-owned). The statistical analyses were performed using hierarchical generalized linear models.

A total of 25 175 patients from 23 regions diagnosed with type-2 diabetes mellitus were indentified from the National Health Insurance claim data in 2000. From that total, 806 cases had at least one diabetic-related preventable hospitalization in 2001. This study found that a higher proportion of people with a higher education in a region, which corresponded with a higher individual income, was associated with a lower risk of diabetes-related preventable hospitalization (OR: 0.99 and 0.81).

The results showed that both individual-level and regional-level socioeconomic status are important factors that are associated with the disparities in diabetes-related preventable hospitalizations.