How social inequalities impact the course of treatment and care for patients with type 2 diabetes mellitus: study protocol for a qualitative cross-sectional study from the patient's perspective

Inequalities in access to community-based diabetes examination and its impact on healthcare utilization among middle-aged and older adults with diabetes in China

Globally, diabetes and its complications are becoming one of the leading challenges in health governance. As health inequalities and primary care services related to diabetes are gaining traction, the status of community-based diabetes examination largely remains unclear in the literature. This study aims to investigate inequalities in access to community-based diabetes examination among people with diabetes and to analyze its impact on healthcare utilization. Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were applied, and a total of 767 patients with diabetes were included. Inequalities in community-based diabetes examination were illustrated by the concentration curve and normalized concentration index. Propensity score matching (PSM) were used to identify the impact of community-based diabetes examination on outpatient and inpatient care utilization. We found that community-based diabetes examination was accessible to 23.08% of the respondents, of which 76.84% were free, and the highest frequency was 2-6 times per year, accounting for 47.46%. Community-based diabetes examinations were more concentrated among people with poorer-economic condition (95% confidence interval, 95%CI = -0.104, p = 0.0035), lower-education level (95%CI = -0.092, p = 0.0129), and less-developed areas (95%CI = -0.103, p = 0.0007). PSM analyses showed that community-based diabetes examination increased the utilization of outpatient care (odds ratio, OR = 1.989, 95%CI = 1.156-3.974) and decreased the use of inpatient care (OR = 0.544, 95%CI = 0.325-0.909), and the sensitivity analyses confirmed the robustness of the results. This study is the first to examine the status and inequalities of community-based regular diabetes examination and its effect on the likelihood of healthcare utilization among patients with diabetes. The findings suggest that the overall level of community-based diabetes examination is low, and there are pro-socioeconomically disadvantaged inequalities. The value of community-based diabetes examination should be recognized to help person with diabetes face up to their health needs for better disease control and health promotion.