Type 2 Diabetes Health Equity Audit in the Basque Public Healthcare Service (Spain)

Health equity audit (HEA) is a systematic procedure to identify inequalities in healthcare access and use, and propose interventions for their reduction. Type 2 diabetes (DM2) is one of the leading causes of disease burden nowadays in Primary Health Care (PHC), and has shown a relevant socioeconomic pattern. This paper aims to present the results of the “equity profile” conducted on secondary and tertiary prevention of DM2 in PHC, being this the first step of any HEA. This was a cross-sectional and retrospective cohort study and the population studied was that living in the Spanish province of Araba in 2010-2011.  Census track based socioeconomic information for each individual was linked to the electronic clinic history of the public Basque Health Service. Age-adjusted prevalences and incidence rates for preventive counselling, screening, treatment, referrals to specialists and consequences were calculated. Moreover the relative index of inequality (RII) was calculated, adjusted for different confounding variables. Main results show that the prevalence of DM2 (men 5.8%; women 4.8%) followed a clear socioeconomic gradient (RII men = 1.35 [1.26-1.44]; RII women= 1.79 [1.66 1.94]), although the relationship varied with age. The poor metabolic control increased by deprivation especially in women (RII = 1.18 [1.02-1.28]), and the probability of having an annual analytical control (RII = 1.14 [1,04-1,25). The referrals to specialists were more frequent among low socioeconomic groups, but the relationship disappeared when considering the metabolic control and complications. These results indicate that even if PHC attention is equitable, relevant inequalities in DM2 persist, which implies the need of looking for interventions to reduce them beyond the health service sector.