BACKGROUND Marked disparities by socioeconomic status in the risk of potentially avoidable hospitalization for chronic illnesses have been observed in many contexts, including those with universal health coverage. Less well known is how gender mediates such differences. We conducted a population-based cohort study to describe associations between household and community-level income and rehospitalizations for types 1 and 2 diabetes mellitus among Canadian women and men. METHODS Our cohorts were drawn from respondents to the 2006 mandatory long-form census linked longitudinally to 3 years of nationally standardized hospital records. We included adults 30-69 years hospitalized with diabetes at least once during the study period. We used logistic regressions to estimate odds ratios for 12-month diabetes rehospitalization associated with indicators of household and community-level income, with separate models by gender, and controlling for a range of other sociodemographic characteristics. Since diabetes may not always be recognized as the main reason for hospitalization, we accounted for disease progression through consideration of admissions where diabetes was previously identified as a secondary diagnosis. RESULTS Among persons hospitalized at least once with diabetes (n = 41,290), 1.5% were readmitted within 12 months where the initial admission had diabetes as the primary diagnosis, and 1.8% were readmitted where the initial admission had diabetes as a secondary diagnosis. For men, being in the lowest household income quintile was associated with higher odds of rehospitalization in cases where the initial admission listed diabetes as either the primary diagnosis (OR = 2.21; 95% CI = 1.38-3.51) or a secondary diagnosis (OR = 1.51; 95% CI = 1.02-2.24). For women, we found no association with income and rehospitalization, but having less than university education was associated with higher odds of rehospitalization where diabetes was a secondary diagnosis of the initial admission (OR = 1.88; 95% CI = 1.21-2.92). We also found positive, but insignificant associations between community-level poverty and odds of rehospitalization. CONCLUSIONS Universal health coverage remains insufficient to eliminate socioeconomic inequalities in preventable diabetes-related hospitalizations, as illustrated in this Canadian context. Decision-makers should tread cautiously with gender-blind poverty reduction actions aiming to enhance population health that may inadequately respond to the different needs of disadvantaged women and men with chronic illness.

中文翻译：

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女性和男性的个人和社区水平收入以及糖尿病再住院的风险：加拿大基于人群的队列研究。


背景 在许多情况下，包括那些具有全民健康覆盖的情况下，都观察到因社会经济地位而导致潜在可避免的慢性病住院风险存在显着差异。不太为人所知的是性别如何调节这种差异。我们进行了一项基于人群的队列研究，以描述加拿大女性和男性的家庭和社区收入与 1 型和 2 型糖尿病再住院之间的关系。方法 我们的队列是从 2006 年强制性长期人口普查的受访者中抽取的，与 3 年国家标准化医院记录纵向相关。我们纳入了在研究期间至少因糖尿病住院一次的 30-69 岁成年人。我们使用逻辑回归来估计与家庭和社区收入指标相关的 12 个月糖尿病再住院的比值比，并按性别建立单独的模型，并控制一系列其他社会人口统计特征。由于糖尿病可能并不总是被认为是住院的主要原因，因此我们通过考虑先前将糖尿病确定为次要诊断的入院情况来解释疾病进展。结果 在至少一次因糖尿病住院的患者中 (n = 41,290)，1.5% 的人在 12 个月内再次入院，其中初次入院时以糖尿病为主要诊断，1.8% 的人在初次入院时以糖尿病为次要诊断而再次入院。对于男性来说，在初次入院时将糖尿病列为主要诊断（OR = 2.21；95% CI = 1.38-3.51）或次要诊断（OR = 1.38-3.51）或次要诊断（OR = 1.51；95% CI = 1.02-2.24）。 对于女性，我们发现与收入和再住院没有关联，但受教育程度低于大学水平与较高的再住院几率相关，其中糖尿病是初次入院的二次诊断（OR = 1.88；95% CI = 1.21-2.92）。我们还发现社区贫困与再住院几率之间存在积极但不显着的关联。结论 正如加拿大的情况所示，全民健康覆盖仍然不足以消除可预防的糖尿病相关住院治疗中的社会经济不平等。决策者应谨慎对待旨在增强人口健康的不分性别的减贫行动，这些行动可能不足以满足弱势女性和患有慢性病的男性的不同需求。