
SES-Related Insulin Pump Uptake Disparities Seen in 2 Canadian Provinces
Using socioeconomic status (SES) as their primary exposure, investigators from McGill University, University of Manitoba, Institut National de Santé Publique du Québec, and Laval University investigated reasons behind insulin pump uptake disparities in the Canadian provinces of Manitoba and Québec.
Investigators from Canada are calling for complete financial coverage of
The authors pointed out all provinces in Canada have universal pediatric coverage programs, and that although these are meant to improve access to the pumps, levels of financial coverage differ among the provinces and that may be a contributing factor to pump uptake disparities.
Their findings were published online today in
Far fewer children in Manitoba were using an insulin pump vs children in Québec (16.7% vs 36.6%) despite the overall mean ages at diagnosis being close to equal, at 8.8 (4.4) and 8.3 (4.4) years, respectively. Age differences surfaced, however, when comparing age at T1D diagnosis between pump and nonpump users in Québec.
In Québec, age of T1D diagnosis was close to 13% younger among pediatric insulin pump users compared with those not using a pump: 7.6 (4.1) vs 8.7 (4.5) years. No age difference at diagnosis was seen in Manitoba among these same groups, nor did the majority sex distribution (male) differ among pump and nonpump users in either province.
“To our knowledge, the pump program in Ontario is the only program that has been systematically evaluated. Among Ontario children with T1D, those of lower SES were less likely to start pump therapy and more likely to discontinue it than those of higher SES,” the authors wrote. “But to our knowledge, comparisons of differing funding structures within a single country have not been performed.” They hypothesized that Québec would have fewer disparities vs Manitoba.
When level of material deprivation/SES was considered, pump uptake dropped in both provinces. In Québec, an 11% drop was seen (adjusted HR [aHR], 0.89; 95% CI, 0.85-0.93), and in Manitoba, there was a 30% drop (aHR, 0.70; 95% CI, 0.60-0.82). These results remained consistent when the investigators considered the influence of ethnicity on pump uptake.
Overall, SES-related pump uptake disparities were greater in Manitoba compared with Québec (I2, 87.7%; 95% CI, 52.5%-96.8%; P = .006; Cochran Q, 8.15), despite the provinces having similar SES profiles, and an inverse linear association was seen between pump uptake and increasing deprivation in both provinces, the authors noted:
- Québec:
- Material deprivation index:
- Pump users: 22.2% in quintile 1 vs 18.1% in quintile 5
- Nonpump group: 17.0% vs 24.8%, respectively
- Social deprivation index:
- Pump users: 26.7% vs 11.6%
- Nonpump group: 22.9% vs 17.2%
- Material deprivation index:
- Manitoba:
- Material deprivation index:
- Pump users: 29.2% vs 6.6%
- Nonpump group: 12.8% vs 20.2%
- Social deprivation index:
- Pump users: 34.9% vs 14.2%
- Nonpump group: 27.4% vs 16.8%
- Material deprivation index:
Quintile 1 is the least deprived and quintile 5, the most deprived.
An
“Future research should examine SES disparities in these devices across same-country jurisdictions and explore the contribution of patient and health care professional factors on disparities in diabetes technology use,” the authors concluded. “Programs aimed at reduction of educational, ethnic, and monetary disparities are essential to improve health equity, and further research into family preferences and health care professional biases are needed to optimize the care of children with T1D.”
Reference
Ladd JM, Sharma A, Rahme E, et al. Comparison of socioeconomic disparities in pump uptake among children with type 1 diabetes in 2 Canadian provinces with different payment models. JAMA Netw Open. Published online May 4, 2022. doi:10.1001/jamanetworkopen.2022.10464
Newsletter
Stay ahead of policy, cost, and value—subscribe to AJMC for expert insights at the intersection of clinical care and health economics.