Regional differences in antihyperglycemic medication are not explained by individual socioeconomic status, regional deprivation, and regional health care services. Observational results from the German DIAB-CORE consortium

PLoS One. 2018 Jan 25;13(1):e0191559. doi: 10.1371/journal.pone.0191559. eCollection 2018.

Abstract

Aims: This population-based study sought to extend knowledge on factors explaining regional differences in type 2 diabetes mellitus medication patterns in Germany.

Methods: Individual baseline and follow-up data from four regional population-based German cohort studies (SHIP [northeast], CARLA [east], HNR [west], KORA [south]) conducted between 1997 and 2010 were pooled and merged with both data on regional deprivation and regional health care services. To analyze regional differences in any or newer anti-hyperglycemic medication, medication prevalence ratios (PRs) were estimated using multivariable Poisson regression models with a robust error variance adjusted gradually for individual and regional variables.

Results: The study population consisted of 1,437 people aged 45 to 74 years at baseline, (corresponding to 49 to 83 years at follow-up) with self-reported type 2 diabetes. The prevalence of receiving any anti-hyperglycemic medication was 16% higher in KORA (PR 1.16 [1.08-1.25]), 10% higher in CARLA (1.10 [1.01-1.18]), and 7% higher in SHIP (PR 1.07 [1.00-1.15]) than in HNR. The prevalence of receiving newer anti-hyperglycemic medication was 49% higher in KORA (1.49 [1.09-2.05]), 41% higher in CARLA (1.41 [1.02-1.96]) and 1% higher in SHIP (1.01 [0.72-1.41]) than in HNR, respectively. After gradual adjustment for individual variables, regional deprivation and health care services, the effects only changed slightly.

Conclusions: Neither comprehensive individual factors including socioeconomic status nor regional deprivation or indicators of regional health care services were able to sufficiently explain regional differences in anti-hyperglycemic treatment in Germany. To understand the underlying causes, further research is needed.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Female
  • Germany / epidemiology
  • Health Services
  • Humans
  • Hypertension / epidemiology
  • Hypoglycemic Agents / pharmacology
  • Hypoglycemic Agents / therapeutic use
  • Life Style
  • Male
  • Middle Aged
  • Models, Statistical
  • Prevalence
  • Regional Medical Programs
  • Social Class
  • Socioeconomic Factors*

Substances

  • Hypoglycemic Agents

Grants and funding

This study was supported by the Competence Network Diabetes Mellitus (http://www.kompetenznetz-diabetes-mellitus.net/, FKZ 01GI1110H) and the German Center for Diabetes Research (https://www.dzd-ev.de/, DZD) both funded by the German Federal Ministry of Education and Research (www.bmbf.de, BMBF). The German Diabetes Center receives institutional funding by the German Ministry of Health and the Ministry of Innovation, Sciences and Research of the Federal State of North Rhine-Westphalia (http://www.wissenschaft.nrw.de/). The HNR Study was supported by the Heinz Nixdorf Foundation, Essen, Germany (http://www.heinz-nixdorf-stiftung.de/home/), the German Ministry of Education and Research (www.bmbf.de, BMBF), the Sarstedt AG & Co. (Nümbrecht, Germany) (https://www.sarstedt.com/home/) for laboratory equipment and the German Research Council (http://www.dfg.de/, DFG; Project SI 236/8-1, SI 236/9-1, ER 155/6-1,2,3). The KORA research platform (KORA, Cooperative Research in the Region of Augsburg) was initiated and financed by the Helmholtz Zentrum München – German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (www.bmbf.de, BMBF) and by the State of Bavaria (http://www.bayern.de/freistaat/). The CARLA study was supported by the Ministry of Education and Cultural Affairs of Saxony-Anhalt (http://mb.sachsen-anhalt.de/ministerium-fuer-bildung/), by the Federal Employment Office, by a grant from the Deutsche Forschungsgemeinschaft (www.dfg.de) as part of the Collaborative Research Centre 598 ‘Heart failure in the elderly – cellular mechanisms and therapy’ at the Medical Faculty of the Martin-Luther-University Halle-Wittenberg, and by a grant from the Wilhelm-Roux Programme of the Martin-Luther-University Halle-Wittenberg (http://www.medizin.uni-halle.de/index.php?id=1248). The SHIP study is part of the Community Medicine Research net (http://www.community-medicine.de) at the University of Greifswald, Germany. Funding was provided by grants from the German Federal Ministry of Education and Research (www.bmbf.de, BMBF, grants 01ZZ9603, 01ZZ0103, 01ZZ0701), the Ministry for Education, Research and Cultural Affairs, and the Ministry for Social Affairs of the Federal State of Mecklenburg–West Pomerania (http://www.regierung-mv.de/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.