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Low Income Diabetes Patients Dying at Higher Rates than Wealthy

Posted: Sunday, January 03, 2010

Despite the drop in fatalities from diabetes over the past decade, patients with lower incomes appear to be dying at a much higher rate than wealthy ones, a new study shows.

The risk of dying if you are in the poorest compared to richest group of adults grew by more than 40 per cent over 11 years, according to the study.  In 1995, the number of low-income people age 30 to 64 with diabetes who died was 1.4 per cent, or 14 in 1,000 people. In higher income people, it was 1.2, or 12 in 1,000 people.

By 2006, while death rates went down overall, mortality rates for lower income adults was .96, or about 10 in 1,000. For higher income people, it was .64, or six in 1,000 people.

"Our finding suggests that wealthier people may have benefited more from advances in diabetes care than poorer people," said the study.

The study looked at mortality rates from 1995 to 2006, for people with diabetes. It compared patients with diabetes from lower and higher income neighborhoods in order to examine how the disease affects people from different backgrounds.

While more people now have the disease in Ontario -- almost 850,000 in 2006 as compared with more 350,000 in 1995 -- mortality rates have dropped by about 30 percent overall, to 2.7 percent in 2006 from four percent in 1995.

Yet in low income groups -- those making about $30,000 or less a year -- those improvements have been less apparent due to rising expenses, said Lorraine Lipscombe, a researcher and diabetes doctor.

"As the cost of diabetes treatments have gone up, and the complexity of diabetes care has increased over the last decade, which of course has translated into improved outcomes for patients ... the lower income patients are less able to afford proper treatment than they used to," said Lipscombe.

"Our worry is that there are differences in access to treatments among incomes." Improved treatments, such as new insulin and blood pressure drugs, can be costly and lower income people are less likely to work in jobs that have private insurance, said Lipscombe.

Another reason for the gap in mortality could be the propensity of lower income people to live unhealthy lifestyles and to be less educated about the disease.

Patients who are obese and have a genetic history of diabetes are more likely to develop diabetes. Some immigrant populations also have higher diabetes rates. "So we may also be seeing an effect of change in culture," said Lipscombe.

While people with diabetes over the age of 65 have higher rates of mortality, the rates essentially remained stable over the past 11 years. That could be because they are eligible for subsidized drugs, the study said.

Source: Diabetes In Control: Institute for Clinical Evaluative Sciences in Toronto.

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