In the Journals

Better medication access needed to address glycemic management disparity across income levels

Canadian adults with diabetes who have the lowest incomes have higher HbA1c levels compared with those with the highest incomes, but researchers argue that universal prescription access can lessen the discrepancy.

“Although all residents have access to universal insurance for hospital and physician services, residents of most provinces lack universal publicly funded drug insurance before the age of 65 years, and instead either rely on private insurance plans through their employer or must pay for medications out-of-pocket,” Baiju Shah, PhD, MD, an associate professor at the department of medicine at the University of Toronto, and colleagues wrote.

Shah and colleagues reviewed HbA1c levels during the first half of 2015 from 583,884 adults with diabetes who had data in the Ontario Diabetes Database. Participants younger than 40 years and those older than 89 years were excluded; information on median neighborhood income was collected from Statistics Canada and used to stratify the participants into five income-level groups (lowest-income group: mean age, 64.9 years; 50.4% women; highest-income group: mean age, 66.2 years; 41.7% women).

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Canadian adults with diabetes who have the lowest incomes have higher HbA1c levels compared with those with the highest incomes, but researchers argue that universal prescription access can lessen the discrepancy.
Adobe Stock

According to the researchers, participants with the lowest income averaged higher HbA1c levels (56 mmol/mol, or 7.3%) vs. those with the highest income (54 mmol/mol, or 7.1%; P < .001). Among all income levels, those aged at least 65 years had superior glycemic control (53 mmol/mol, or 7%) compared with those younger than 65 years (57 mmol/mol, or 7.4%; (P < .001). The researchers added that “age was a statistically significant modifier of the effect of income,” with a wider gap in average HbA1c measures between income levels for those younger than 65 years vs. those aged at least 65 years.

“Our findings highlight that lower-income populations with diabetes in Canada have poorer glycemic control compared to their higher-income counterparts, despite access to publicly funded health care,” the researchers wrote. “Health policy solutions to bridge this gap are likely to be multidimensional, but based on the results of the present study might include broadening drug insurance coverage to those aged < 65 years to reduce health inequalities and the burden of diabetes in society.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.

Canadian adults with diabetes who have the lowest incomes have higher HbA1c levels compared with those with the highest incomes, but researchers argue that universal prescription access can lessen the discrepancy.

“Although all residents have access to universal insurance for hospital and physician services, residents of most provinces lack universal publicly funded drug insurance before the age of 65 years, and instead either rely on private insurance plans through their employer or must pay for medications out-of-pocket,” Baiju Shah, PhD, MD, an associate professor at the department of medicine at the University of Toronto, and colleagues wrote.

Shah and colleagues reviewed HbA1c levels during the first half of 2015 from 583,884 adults with diabetes who had data in the Ontario Diabetes Database. Participants younger than 40 years and those older than 89 years were excluded; information on median neighborhood income was collected from Statistics Canada and used to stratify the participants into five income-level groups (lowest-income group: mean age, 64.9 years; 50.4% women; highest-income group: mean age, 66.2 years; 41.7% women).

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Canadian adults with diabetes who have the lowest incomes have higher HbA1c levels compared with those with the highest incomes, but researchers argue that universal prescription access can lessen the discrepancy.
Adobe Stock

According to the researchers, participants with the lowest income averaged higher HbA1c levels (56 mmol/mol, or 7.3%) vs. those with the highest income (54 mmol/mol, or 7.1%; P < .001). Among all income levels, those aged at least 65 years had superior glycemic control (53 mmol/mol, or 7%) compared with those younger than 65 years (57 mmol/mol, or 7.4%; (P < .001). The researchers added that “age was a statistically significant modifier of the effect of income,” with a wider gap in average HbA1c measures between income levels for those younger than 65 years vs. those aged at least 65 years.

“Our findings highlight that lower-income populations with diabetes in Canada have poorer glycemic control compared to their higher-income counterparts, despite access to publicly funded health care,” the researchers wrote. “Health policy solutions to bridge this gap are likely to be multidimensional, but based on the results of the present study might include broadening drug insurance coverage to those aged < 65 years to reduce health inequalities and the burden of diabetes in society.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.