Treatment pattern of type 2 diabetes differs in two German regions and with patients' socioeconomic position
Diabetes treatment may differ by region and patients' socioeconomic position. This may be particularly true for newer drugs. However, data are highly limited. We examined pooled individual data of two population-based German studies, KORA F4 (Cooperative Health Research in the Region of Augsbur...
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| Veröffentlicht in: | PloS one 2014-06, Vol.9 (6), p.e99773 |
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| creator | Tamayo, Teresa Claessen, Heiner Rückert, Ina-Maria Maier, Werner Schunk, Michaela Meisinger, Christine Mielck, Andreas Holle, Rolf Thorand, Barbara Narres, Maria Moebus, Susanne Mahabadi, Amir-Abbas Pundt, Noreen Krone, Bastian Slomiany, Uta Erbel, Raimund Jöckel, Karl-Heinz Rathmann, Wolfgang Icks, Andrea |
| description | Diabetes treatment may differ by region and patients' socioeconomic position. This may be particularly true for newer drugs. However, data are highly limited.
We examined pooled individual data of two population-based German studies, KORA F4 (Cooperative Health Research in the Region of Augsburg, south), and the HNR (Heinz Nixdorf Recall study, west) both carried out 2006 to 2008. To ascertain the association between region and educational level with anti-hyperglycemic medication we fitted poisson regression models with robust error variance for any and newer anti-hyperglycemic medication, adjusting for age, sex, diabetes duration, BMI, cardiovascular disease, lifestyle, and insurance status.
The examined sample comprised 662 participants with self-reported type 2 diabetes (KORA F4: 83 women, 111 men; HNR: 183 women, 285 men). The probability to receive any anti-hyperglycemic drug as well as to be treated with newer anti-hyperglycemic drugs such as insulin analogues, thiazolidinediones, or glinides was significantly increased in southern compared to western Germany (prevalence ratio (PR); 95% CI: 1.12; 1.02-1.22, 1.52;1.10-2.11 respectively). Individuals with lower educational level tended to receive anti-hyperglycemic drugs more likely than their better educated counterparts (PR; 95% CI univariable: 1.10; 0.99-1.22; fully adjusted: 1.10; 0.98-1.23). In contrast, lower education was associated with a lower estimated probability to receive newer drugs among those with any anti-hyperglycemic drugs (PR low vs. high education: 0.66; 0.48-0.91; fully adjusted: 0.68; 0.47-0.996).
We found regional and individual social disparities in overall and newer anti-hyperglycemic medication which were not explained by other confounders. Further research is needed. |
| doi_str_mv | 10.1371/journal.pone.0099773 |
| format | Article |
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We examined pooled individual data of two population-based German studies, KORA F4 (Cooperative Health Research in the Region of Augsburg, south), and the HNR (Heinz Nixdorf Recall study, west) both carried out 2006 to 2008. To ascertain the association between region and educational level with anti-hyperglycemic medication we fitted poisson regression models with robust error variance for any and newer anti-hyperglycemic medication, adjusting for age, sex, diabetes duration, BMI, cardiovascular disease, lifestyle, and insurance status.
The examined sample comprised 662 participants with self-reported type 2 diabetes (KORA F4: 83 women, 111 men; HNR: 183 women, 285 men). The probability to receive any anti-hyperglycemic drug as well as to be treated with newer anti-hyperglycemic drugs such as insulin analogues, thiazolidinediones, or glinides was significantly increased in southern compared to western Germany (prevalence ratio (PR); 95% CI: 1.12; 1.02-1.22, 1.52;1.10-2.11 respectively). Individuals with lower educational level tended to receive anti-hyperglycemic drugs more likely than their better educated counterparts (PR; 95% CI univariable: 1.10; 0.99-1.22; fully adjusted: 1.10; 0.98-1.23). In contrast, lower education was associated with a lower estimated probability to receive newer drugs among those with any anti-hyperglycemic drugs (PR low vs. high education: 0.66; 0.48-0.91; fully adjusted: 0.68; 0.47-0.996).
We found regional and individual social disparities in overall and newer anti-hyperglycemic medication which were not explained by other confounders. Further research is needed.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0099773</identifier><identifier>PMID: 24915157</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Alcohol ; Analysis ; Biometrics ; Body mass ; Cardiology ; Cardiovascular diseases ; Care and treatment ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - economics ; Diabetes therapy ; Drugs ; Education ; Environmental health ; Epidemiology ; Family income ; Female ; Germany ; Glucose ; Health care policy ; Health economics ; Health informatics ; Hemoglobin ; Hospitals ; Humans ; Hyperglycemia - drug therapy ; Hyperglycemia - economics ; Hypertension ; Hypoglycemic Agents - therapeutic use ; Insulin ; Male ; Medicine and Health Sciences ; Patients ; Physicians ; Poisson density functions ; Population ; Population studies ; Prescription drugs ; Public health ; Regression analysis ; Regression models ; Robustness (mathematics) ; Social aspects ; Socioeconomic Factors ; Socioeconomics ; Statistical analysis ; Studies ; Thiazolidinediones ; Type 2 diabetes</subject><ispartof>PloS one, 2014-06, Vol.9 (6), p.e99773</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014 Tamayo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Tamayo et al 2014 Tamayo et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-801b0f40db9d44623d66a6ae570e5c051d2546dba59caaa791dff74f17617cb13</citedby><cites>FETCH-LOGICAL-c692t-801b0f40db9d44623d66a6ae570e5c051d2546dba59caaa791dff74f17617cb13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051778/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051778/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24915157$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Berthold, Heiner K.</contributor><creatorcontrib>Tamayo, Teresa</creatorcontrib><creatorcontrib>Claessen, Heiner</creatorcontrib><creatorcontrib>Rückert, Ina-Maria</creatorcontrib><creatorcontrib>Maier, Werner</creatorcontrib><creatorcontrib>Schunk, Michaela</creatorcontrib><creatorcontrib>Meisinger, Christine</creatorcontrib><creatorcontrib>Mielck, Andreas</creatorcontrib><creatorcontrib>Holle, Rolf</creatorcontrib><creatorcontrib>Thorand, Barbara</creatorcontrib><creatorcontrib>Narres, Maria</creatorcontrib><creatorcontrib>Moebus, Susanne</creatorcontrib><creatorcontrib>Mahabadi, Amir-Abbas</creatorcontrib><creatorcontrib>Pundt, Noreen</creatorcontrib><creatorcontrib>Krone, Bastian</creatorcontrib><creatorcontrib>Slomiany, Uta</creatorcontrib><creatorcontrib>Erbel, Raimund</creatorcontrib><creatorcontrib>Jöckel, Karl-Heinz</creatorcontrib><creatorcontrib>Rathmann, Wolfgang</creatorcontrib><creatorcontrib>Icks, Andrea</creatorcontrib><title>Treatment pattern of type 2 diabetes differs in two German regions and with patients' socioeconomic position</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Diabetes treatment may differ by region and patients' socioeconomic position. This may be particularly true for newer drugs. However, data are highly limited.
We examined pooled individual data of two population-based German studies, KORA F4 (Cooperative Health Research in the Region of Augsburg, south), and the HNR (Heinz Nixdorf Recall study, west) both carried out 2006 to 2008. To ascertain the association between region and educational level with anti-hyperglycemic medication we fitted poisson regression models with robust error variance for any and newer anti-hyperglycemic medication, adjusting for age, sex, diabetes duration, BMI, cardiovascular disease, lifestyle, and insurance status.
The examined sample comprised 662 participants with self-reported type 2 diabetes (KORA F4: 83 women, 111 men; HNR: 183 women, 285 men). The probability to receive any anti-hyperglycemic drug as well as to be treated with newer anti-hyperglycemic drugs such as insulin analogues, thiazolidinediones, or glinides was significantly increased in southern compared to western Germany (prevalence ratio (PR); 95% CI: 1.12; 1.02-1.22, 1.52;1.10-2.11 respectively). Individuals with lower educational level tended to receive anti-hyperglycemic drugs more likely than their better educated counterparts (PR; 95% CI univariable: 1.10; 0.99-1.22; fully adjusted: 1.10; 0.98-1.23). In contrast, lower education was associated with a lower estimated probability to receive newer drugs among those with any anti-hyperglycemic drugs (PR low vs. high education: 0.66; 0.48-0.91; fully adjusted: 0.68; 0.47-0.996).
We found regional and individual social disparities in overall and newer anti-hyperglycemic medication which were not explained by other confounders. Further research is needed.</description><subject>Aged</subject><subject>Alcohol</subject><subject>Analysis</subject><subject>Biometrics</subject><subject>Body mass</subject><subject>Cardiology</subject><subject>Cardiovascular diseases</subject><subject>Care and treatment</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes Mellitus, Type 2 - economics</subject><subject>Diabetes therapy</subject><subject>Drugs</subject><subject>Education</subject><subject>Environmental health</subject><subject>Epidemiology</subject><subject>Family income</subject><subject>Female</subject><subject>Germany</subject><subject>Glucose</subject><subject>Health care policy</subject><subject>Health economics</subject><subject>Health informatics</subject><subject>Hemoglobin</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hyperglycemia - drug therapy</subject><subject>Hyperglycemia - economics</subject><subject>Hypertension</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Insulin</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Patients</subject><subject>Physicians</subject><subject>Poisson density functions</subject><subject>Population</subject><subject>Population studies</subject><subject>Prescription drugs</subject><subject>Public health</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Robustness (mathematics)</subject><subject>Social aspects</subject><subject>Socioeconomic Factors</subject><subject>Socioeconomics</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Thiazolidinediones</subject><subject>Type 2 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pattern of type 2 diabetes differs in two German regions and with patients' socioeconomic position</title><author>Tamayo, Teresa ; Claessen, Heiner ; Rückert, Ina-Maria ; Maier, Werner ; Schunk, Michaela ; Meisinger, Christine ; Mielck, Andreas ; Holle, Rolf ; Thorand, Barbara ; Narres, Maria ; Moebus, Susanne ; Mahabadi, Amir-Abbas ; Pundt, Noreen ; Krone, Bastian ; Slomiany, Uta ; Erbel, Raimund ; Jöckel, Karl-Heinz ; Rathmann, Wolfgang ; Icks, Andrea</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-801b0f40db9d44623d66a6ae570e5c051d2546dba59caaa791dff74f17617cb13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Alcohol</topic><topic>Analysis</topic><topic>Biometrics</topic><topic>Body mass</topic><topic>Cardiology</topic><topic>Cardiovascular diseases</topic><topic>Care and treatment</topic><topic>Diabetes</topic><topic>Diabetes 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Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tamayo, Teresa</au><au>Claessen, Heiner</au><au>Rückert, Ina-Maria</au><au>Maier, Werner</au><au>Schunk, Michaela</au><au>Meisinger, Christine</au><au>Mielck, Andreas</au><au>Holle, Rolf</au><au>Thorand, Barbara</au><au>Narres, Maria</au><au>Moebus, Susanne</au><au>Mahabadi, Amir-Abbas</au><au>Pundt, Noreen</au><au>Krone, Bastian</au><au>Slomiany, Uta</au><au>Erbel, Raimund</au><au>Jöckel, Karl-Heinz</au><au>Rathmann, Wolfgang</au><au>Icks, Andrea</au><au>Berthold, Heiner K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment pattern of type 2 diabetes differs in two German regions and with patients' socioeconomic position</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-06-10</date><risdate>2014</risdate><volume>9</volume><issue>6</issue><spage>e99773</spage><pages>e99773-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Diabetes treatment may differ by region and patients' socioeconomic position. This may be particularly true for newer drugs. However, data are highly limited.
We examined pooled individual data of two population-based German studies, KORA F4 (Cooperative Health Research in the Region of Augsburg, south), and the HNR (Heinz Nixdorf Recall study, west) both carried out 2006 to 2008. To ascertain the association between region and educational level with anti-hyperglycemic medication we fitted poisson regression models with robust error variance for any and newer anti-hyperglycemic medication, adjusting for age, sex, diabetes duration, BMI, cardiovascular disease, lifestyle, and insurance status.
The examined sample comprised 662 participants with self-reported type 2 diabetes (KORA F4: 83 women, 111 men; HNR: 183 women, 285 men). The probability to receive any anti-hyperglycemic drug as well as to be treated with newer anti-hyperglycemic drugs such as insulin analogues, thiazolidinediones, or glinides was significantly increased in southern compared to western Germany (prevalence ratio (PR); 95% CI: 1.12; 1.02-1.22, 1.52;1.10-2.11 respectively). Individuals with lower educational level tended to receive anti-hyperglycemic drugs more likely than their better educated counterparts (PR; 95% CI univariable: 1.10; 0.99-1.22; fully adjusted: 1.10; 0.98-1.23). In contrast, lower education was associated with a lower estimated probability to receive newer drugs among those with any anti-hyperglycemic drugs (PR low vs. high education: 0.66; 0.48-0.91; fully adjusted: 0.68; 0.47-0.996).
We found regional and individual social disparities in overall and newer anti-hyperglycemic medication which were not explained by other confounders. Further research is needed.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24915157</pmid><doi>10.1371/journal.pone.0099773</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2014-06, Vol.9 (6), p.e99773 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1534520972 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Aged Alcohol Analysis Biometrics Body mass Cardiology Cardiovascular diseases Care and treatment Diabetes Diabetes mellitus Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - economics Diabetes therapy Drugs Education Environmental health Epidemiology Family income Female Germany Glucose Health care policy Health economics Health informatics Hemoglobin Hospitals Humans Hyperglycemia - drug therapy Hyperglycemia - economics Hypertension Hypoglycemic Agents - therapeutic use Insulin Male Medicine and Health Sciences Patients Physicians Poisson density functions Population Population studies Prescription drugs Public health Regression analysis Regression models Robustness (mathematics) Social aspects Socioeconomic Factors Socioeconomics Statistical analysis Studies Thiazolidinediones Type 2 diabetes |
| title | Treatment pattern of type 2 diabetes differs in two German regions and with patients' socioeconomic position |
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