Association between area-level socioeconomic status, accessibility and diabetes-related hospitalisations: a cross-sectional analysis of data from Western Victoria, Australia

Sajjad, Muhammad A, Holloway-Kew, Kara L, Mohebbi, Mohammadreza, Kotowicz, Mark A, de Abreu, Lelia LF, Livingston, Patricia M, Khasraw, Mustafa, Hakkennes, Sharon, Dunning, Trisha L, Brumby, Susan, Page, Richard S, Sutherland, Alasdair G, Venkatesh, Svetha, Williams, Lana J, Brennan-Olsen, Sharon L and Pasco, Julie A 2019, Association between area-level socioeconomic status, accessibility and diabetes-related hospitalisations: a cross-sectional analysis of data from Western Victoria, Australia, BMJ open, vol. 9, no. 5, pp. 1-9, doi: 10.1136/bmjopen-2018-026880.

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Title Association between area-level socioeconomic status, accessibility and diabetes-related hospitalisations: a cross-sectional analysis of data from Western Victoria, Australia
Author(s) Sajjad, Muhammad A
Holloway-Kew, Kara L
Mohebbi, MohammadrezaORCID iD for Mohebbi, Mohammadreza orcid.org/0000-0001-9713-7211
Kotowicz, Mark AORCID iD for Kotowicz, Mark A orcid.org/0000-0002-8094-1411
de Abreu, Lelia LF
Livingston, Patricia MORCID iD for Livingston, Patricia M orcid.org/0000-0001-6616-3839
Khasraw, MustafaORCID iD for Khasraw, Mustafa orcid.org/0000-0003-3249-9849
Hakkennes, Sharon
Dunning, Trisha LORCID iD for Dunning, Trisha L orcid.org/0000-0002-0284-1706
Brumby, SusanORCID iD for Brumby, Susan orcid.org/0000-0001-6332-3374
Page, Richard SORCID iD for Page, Richard S orcid.org/0000-0002-2225-7144
Sutherland, Alasdair G
Venkatesh, SvethaORCID iD for Venkatesh, Svetha orcid.org/0000-0001-8675-6631
Williams, Lana JORCID iD for Williams, Lana J orcid.org/0000-0002-1377-1272
Brennan-Olsen, Sharon L
Pasco, Julie AORCID iD for Pasco, Julie A orcid.org/0000-0002-8968-4714
Journal name BMJ open
Volume number 9
Issue number 5
Article ID e026880
Start page 1
End page 9
Total pages 9
Publisher BMJ Publishing Group
Place of publication London, Eng.
Publication date 2019-06
ISSN 2044-6055
2044-6055
Keyword(s) accessibility
diabetes mellitus
hospitalisation
remoteness
socioeconomic status
Summary OBJECTIVE: Hospitalisation rates for many chronic conditions are higher in socioeconomically disadvantaged and less accessible areas. We aimed to map diabetes hospitalisation rates by local government area (LGA) across Western Victoria, Australia, and investigate their association with socioeconomic status (SES) and accessibility/remoteness. DESIGN: Cross-sectional study METHODS: Data were acquired from the Victorian Admitted Episodes Dataset for all hospitalisations (public and private) with a diagnosis of type 1 or type 2 diabetes mellitus during 2011-2014. Crude and age-standardised hospitalisation rates (per 1000 population per year) were calculated by LGA for men, women and combined data. Associations between accessibility (Accessibility/Remoteness Index of Australia, ARIA), SES (Index of Relative Socioeconomic Advantage and Disadvantage, IRSAD) and diabetes hospitalisation were investigated using Poisson regression analyses. RESULTS: Higher LGA-level accessibility and SES were associated with higher rates of type 1 and type 2 diabetes hospitalisation, overall and for each sex. For type 1 diabetes, higher accessibility (ARIA category) was associated with higher hospitalisation rates (men incidence rate ratio [IRR]=2.14, 95% CI 1.64 to 2.80; women IRR=2.45, 95% CI 1.87 to 3.19; combined IRR=2.30, 95% CI 1.69 to 3.13; all p<0.05). Higher socioeconomic advantage (IRSAD decile) was also associated with higher hospitalisation rates (men IRR=1.25, 95% CI 1.09 to 1.43; women IRR=1.32, 95% CI 1.16 to 1.51; combined IRR=1.23, 95% CI 1.07 to 1.42; all p<0.05). Similarly, for type 2 diabetes, higher accessibility (ARIA category) was associated with higher hospitalisation rates (men IRR=2.49, 95% CI 1.81 to 3.43; women IRR=2.34, 95% CI 1.69 to 3.25; combined IRR=2.32, 95% CI 1.66 to 3.25; all p<0.05) and higher socioeconomic advantage (IRSAD decile) was also associated with higher hospitalisation rates (men IRR=1.15, 95% CI 1.02 to 1.30; women IRR=1.14, 95% CI 1.01 to 1.28; combined IRR=1.13, 95% CI 1.00 to 1.27; all p<0.05). CONCLUSION: Our observations could indicate self-motivated treatment seeking, and better specialist and hospital services availability in the advantaged and accessible areas in the study region. The determinants for such variations in hospitalisation rates, however, are multifaceted and warrant further research.
Language eng
DOI 10.1136/bmjopen-2018-026880
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2019, Author(s) (or their employer(s))
Persistent URL http://hdl.handle.net/10536/DRO/DU:30122364

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