Relationship between health care insurance status, social determinants and prevalence of diabetes-related microvascular complications in patients with type 1 diabetes: a nationwide survey in Brazil
To evaluate the relationship between social determinants, health care insurance status and occurrence of diabetes-related chronic complications (DRCC) in Brazilian patients with type 1 diabetes.
A multicenter cross-sectional study conducted between August 2011 and August 2014 in 14 public clinics in 10 Brazilian cities. Data were obtained from 1760 patients, aged 29.9 ± 11.9 years, with diabetes duration of 15.5 ± 9.3 years; 55.9% female, 54.5% Caucasians, 69.7% were attended exclusively by the public Brazilian National Health Care System (BNHCS) and 30.3% had also private health care insurance. Patients’ information was obtained through a questionnaire and a chart review form.
The social determinants associated with having both private and public health care insurance were being employed, belonging to medium or high socioeconomic status, having more years of school attendance and having younger age. Regarding DRCC, patients that had private and public health care had lower rates of diabetic retinopathy and of any other DRCC. Chronic kidney disease was not associated with health care coverage status after adjusting for classical clinical risk factors.
Brazilian patients with type 1 diabetes had better clinical control and lower rates of DRCC, mainly retinopathy, when also having private health care insurance. These patients presented less frequently predictors of chronic complications such as high levels of HbA1c and blood pressure. BNHCS should change the approach for screening DRCC such as diabetic retinopathy, using methods such as telemedicine that would lead to earlier diagnosis, better outcomes and will be cost-effective sometime after its implementation.
KeywordsType 1 diabetes Microvascular chronic complications Health care insurance Retinopathy
Funding was provided by Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (E-26/110.170/2013) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (563753/2010-2).
Compliance with ethical standards
Conflict of interest
The authors declare they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 16.Robert J, Roudier C, Poutignat N et al (2009) Prise en charge des personnes diabétiques de type 2 en France en 2007 et tendances par rapport à 2001. Bull Epidemiol Hebd 42(43):455–459Google Scholar
- 18.ANS-Agencia Nacional de Saude Suplementar (2018) http://www.ans.gov.br/. Accessed 26 May 2018
- 32.IBGE Censo 2010 (2015) http://www.censo2010.ibge.gov.br/sinopse/index.php?dados=8. Accessed 10 Oct 2015
- 34.Criterio Brasil-ABEP (2015) http://www.abep.org/criterio-brasil. Accessed 13 May 2016
- 35.Índice de Desempenho do Sistema Único de Saúde (2018) http://idsus.saude.gov.br/. Accessed 26 May 2018
- 36.IESS-Instituto de Estudos de Saude Suplementar (2018) https://iess.org.br/?p=publicacoes&id_tipo=15. Accessed 26 May 2018
- 40.CBO-Conselho Brasileiro de Oftalmologia-Censo 2014 (2018) http://www.cbo.net.br/novo/classe-medica/censo-2014.php. Accessed 01 July 2018
- 41.Anexo I-relação de procedimentos SUS (2018) http://www.saude.pi.gov.br/uploads/bidding_document/file/96/Anexo_I_Procedimentos_Completo.xlsx. Accessed 14 Aug 2018
- 42.Tabela de preços (2018) http://www.stf.jus.br/repositorio/cms/stfMed/stfMed2Prestador/anexo/Copia_de_tuss.xls. Accessed 14 Aug 2018
- 45.Tabela SUS 1 (2018) https://www.lagoasanta.mg.gov.br/attachments/article/1827/TABELA%20SIA.SUS.pdf. Accessed 14 Aug 2018