Disentangling the influence of living place and socioeconomic position on health services use among diabetes patients: A population-based study.

This research investigates the influence of place of residence and diabetic patient's socioeconomic position on their use of health services in a universal health care system. This retrospective cross-sectional population-based study is based on the joint use of the Health Insurance information systems, an ecological indicator of social deprivation and an indicator of potential spatial accessibility of healthcare provision in the Midi-Pyrénées region. Using French healthcare insurance population-based data on reimbursement of out-of-hospital care during the year 2012, we study the use of health services among patients aged 50 and over (n = 90,136).We built logistic regression models linking health services use to socioeconomic position by geographic area, adjusted for age, gender, healthcare provision, information regarding patients precariousness, and long-term condition, used as proxy for the state of health. After adjustment for healthcare provision, the lower population density in the geographical area of concern, the lower the access to specialised care, independent of the patients' SEP. General practitioner attendance was higher among the patients with the lowest SEP without being clearly influenced by their living place. We found no clear influence of either patients' SEP or their living place on their access to biological follow-up. This study is an attempt to account for the geographical context and to go further in studying the social determinants of health among diabetes patients.

[Use of medical and administrative databases to measure social health inequalities]. / Les bases médico-administratives pour mesurer les inégalités sociales de santé.

OBJECTIVE: The ability to measure social health inequalities is a prerequisite to the implementation of local policies designed to reduce such inequalities. The absence of individual socioeconomic data in medical and administrative databases does not allow direct evaluation of those inequalities. The objective of this study is to propose a method of measurement of social health inequalities from national health insurance databases and a validated deprivation index. METHODS: 27 health care and prevention indicators were constructed to identify social health inequalities. Medical and administrative databases were cross-matched with the European Deprivation Index, completed by a potential spatial accessibility indicator in order to take into account the spatial distribution health care services. RESULTS: The study population comprised data devived from the three main health insurance schemes, and represents 89% of the population of the Midi-Pyrenees region. 98% were able to be geographically coded. The 27 indicators were therefore calculated on a total of 2,574,310 individuals, i.e. 87% of the regional population. CONCLUSION: This study illustrates the value of using medical and administrative data to create databases allowing measurement of social health inequalities and their variations within a region. The proposed indicators could be used as decision-making tools for the selection of zones of intervention and to assess the impact of public policies designed to reduce social health inequalities.