Socioeconomic differences in mortality among diabetic people in Finland: five year follow up

Abstract Objective: To compare socioeconomic differences in mortality (by cause of death) among diabetic people with those in the rest of the population. Design: Five year follow up of mortality in the population of Finland, comparing people with diabetes and those without diabetes. Setting: Finland. Subjects: All residents of Finland aged 30 to 74 included in the 1980 census. Subjects were classified as diabetic (230 000 person years) or other (12 400 000 person years) according to whether they were exempted from charges for medication for diabetes. During 1981–5 there were 114 058 deaths, of which 11 215 were in people with diabetes. Main outcome measures: Age standardised mortality by sex, social class, and cause of death for the diabetic and non-diabetic populations. Results: No significant social class differences in mortality were found among women with diabetes. Among diabetic men there was a slight increasing trend in mortality from the upper white collar group to the unskilled blue collar workers but it was much less steep than that of non-diabetic men. Conclusions: Among people with diabetes in Finland the quality of treatment and compliance with treatment probably do not vary by socioeconomic status. Health education for diabetic people seems to be effective in all socioeconomic strata; in people from the lower strata this leads to greater changes because their health behaviour was originally less good. Key messages In diabetic men a slight increasing trend in mortality was found from the upper white collar group to the unskilled blue collar workers, but it was much less steep than that in non-diabetic men These results may show that among diabetic people in Finland health education is effective in all socioeconomic strata, leading to greater changes in the lower strata due to their poor original health behaviour Equitable health services may alleviate health inequities in a subpopulation where the impact of health services is particularly important