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Understanding Determinants of Health in Type 2 Diabetes Open Access


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Institute of Health Economics
Maddigan, Sheri L.
Feeny, David H.
Majumdar, Sumit R.
Farris, Karen B.
Johnson, Jeffrey A.
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Diabetes Mellitus
Socioeconomic Impacts
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Objective To assess a broad range of determinants of health to determine which are most strongly associated with health-related quality of life (HRQL) in people with type 2 diabetes. Methods This study used respondents from Canadian Community Health Survey Cycle 1.1 who were over the age of 18 and were identified as having type 2 diabetes. Regression analyses were used to assess the relationships between the Health Utilities Index Mark 3 (HUI3) and determinants of health, including sociodemographics, comorbidities, health behaviors, physical and social environmental factors, and indicators of access to healthcare. Results The average age of the analysis sample (n = 4,678) was 61.6 (Standard Deviation (SD) 13.3), with an average duration of diabetes of 9.3 (9.8) years. Approximately, 51.7% of respondents were male. The average overall HUI3 score was 0.78 (0.26). Comorbidities had the largest impact on HRQL, with stroke (-0.11; 95% CI -0.17 to -0.06) and depression (-0.11; 95% CI -0.15 to -0.06) being associated with the largest deficits. Large differences in HRQL were also observed according to two markers of socio-economic status: social assistance (-0.07; 95% CI -0.12 to - 0.03) and food insecurity (-0.07; 95% CI -0.10 to -0.04). Insulin use was associated with a clinically important HRQL deficit (-0.04; 95% CI -0.08 to -0.01), as was having less than secondary education, relative to having a university degree (-0.04; 95% CI -0.07 to -0.02). Overall, the determinants of health model explained 36% of the variance in HUI3. Conclusions These results demonstrated that while many social and environmental factors impact the health of individuals with type 2 diabetes, comorbidities such as cardiovascular disease and depression have the largest impact on HRQL for people with type 2 diabetes. (IHE Working Paper 05-01)
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