Rural-urban disparities in diabetes diagnosis and outcomes in Newfoundland and Labrador

Ibrahim, Ereny (2016) Rural-urban disparities in diabetes diagnosis and outcomes in Newfoundland and Labrador. Masters thesis, Memorial University of Newfoundland.

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Abstract

Newfoundland and Labrador (NL) has the highest prevalence of type 2 diabetes in Canada. Rural populations often lack adequate access to primary care services, which are critical for providing quality diabetes care. To assess diabetes diagnosis and outcomes among rural and urban populations, a population-based, retrospective cohort study of residents NL, Canada, with diagnosed diabetes aged ≥ 20 years old, was performed using an administrative database. The study population included was 17,796 subjects. Diabetes was classified as a complex case if comorbidities were already present at diagnosis. The provincial mortality database was used to determine mortality. The presence of complications/comorbidities was derived from patient billing data collected by the provincial medical care plan during the study period. Patients were geo-referenced using 6 digit postal code. Different levels of analysis were performed. Individual level analysis, including bivariate and multivariate analyses using STATA. Geospatial analysis inclduing visualization and community level analysis using ArcMap-GIS 10.2.. The individual-level model showed that complex cases (OR: 1.23, 95% CI: 1.19-1.28) and mortality (OR: 1.11, 95%CI: 1.07-1.16) were more likely in rural areas. The community-level model found that complex cases were more likely in rural areas (b=18.09, p< .0.05), while no relation was found between mortality and living in remote areas (b=3.53, p= 0.531). This project identified higher prevalence of complex cases in rural areas. This study suggests geographic differences should be taken into account for making better health-related decisions in diabetes care and management.

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