Low income impacts on diabetes incidence in Ontario

By Sally Robertson, B.Sc.Jan 25 2013

Canadian researchers have found that diabetes incidence is inversely related to income in the province of Ontario.

"Study of the Ontario population has already shown significant mortality difference in patients according to income in patients with diabetes," say Lorraine Lipscombe (Women's college Research Institute, Toronto) and team. "We now see that this is the population for whom the relative risk of developing diabetes is the greatest as well."

However, the income disparity was not equal in all populations, with women and younger people (aged under 40 years) the most vulnerable to developing the condition.

Diabetes prevention should be targeted to appropriate populations and healthcare costs should be budgeted to support younger and female lower-income populations, suggest Lipscombe and colleagues.

In an analysis of healthcare databases, the researchers found that between April 2006 and March 2007, 88,886 new cases of diabetes were identified in Ontario, with a mean age at diagnosis of 59 years.

Diabetes incidence was significantly higher among individuals from the lowest versus the highest quintiles for income, at rates of 8.70 versus 7.25 per 1000 people.

Multivariate analysis also showed that diabetes incidence was significantly higher among individuals from lowest versus highest quintiles for income, a trend that was seen across all age groups and in both males and females.

However, as reported in Diabetes Research and Clinical Practice, significant interactions were observed between income quintile and age groups. Among younger people from the lowest quartile for income, the risk for incident diabetes was 1.5 times higher than in those from the highest quintile for income. This difference narrowed with increasing age, with those aged 40-59 years at a 1.38-fold greater risk and those aged 60 or older at a 1.2-fold greater risk.

The finding that the income gap is more marked in younger people is "alarming" say the researchers, "given their longer lifetime duration of disease and potential complications."

"These patients will require long-term intensive health care to avoid complications, and financial barriers may impede adequate access to diabetes treatment and monitoring," they add.

The team also found that women experienced a wider gap in relative risk for diabetes according to income across all age groups, while in men, the gap narrowed with increasing age.

"Greater diabetes prevention efforts need to be directed toward younger and female, low-income populations in order to lessen the lifelong burden of diabetes on the health and productivity of an already disadvantaged population," concludes the team.

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