AUTHOR=Deng Qingwen , Wei Yan , Chen Yingyao 

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

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.956883

DOI=10.3389/fpubh.2022.956883

ISSN=2296-2565

ABSTRACT=Globally, diabetes and its complications are becoming one of the leading challenges in health governance. 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 (CI = –0.104, P = 0.0035), lower education level (CI = –0.092, P = 0.0129), and less developed areas (CI = –0.103, P = 0.0007). PSM analyses showed that community-based diabetes examination increased the utilization of outpatient care (OR=1.989, 95%CI=1.156 to 3.974) and decreased the use of inpatient care (OR=0.544, 95%CI=0.325 to 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.