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Demographic and regional disparities in insulin pump utilization in a setting of universal funding: a New Zealand nationwide study

Abstract

Aims

Insulin pumps have been publically funded in New Zealand since 2012 for patients who meet certain clinical criteria; however, the patterns of utilization have not been described. We undertook a nationwide study to estimate the annual proportions of patients with type 1 diabetes mellitus who used a pump between 2012 and 2014, overall, and according to sex, age, ethnicity, socioeconomic position, and region.

Methods

We used data from the New Zealand Virtual Diabetes Register and routinely collected national demographic, health, and pharmaceutical dispensing data from the Ministry of Health to identify patients with type 1 diabetes and to calculate the overall, and subgroup, proportions using pumps.

Results

Between 2012 and 2014, funded pump use among patients with type 1 diabetes (n = 13,727) increased from 1.8 to 9.3 % overall; however, there were differences in uptake according to demographic characteristics and region. In 2014, proportionate pump use was significantly higher in females versus males (adjusted odds ratio (OR) 2.0 [95 % confidence interval 1.8–2.3]), in those aged <20 years, and in some regions. Māori (indigenous people), Pacific, and Asian patients were significantly less likely to use pumps than New Zealand Europeans (ORs 0.30 [0.23–0.41], 0.26 [0.14–0.46], 0.22 [0.14–0.35], respectively), as were those in the most versus the least deprived socioeconomic decile (OR 0.36 [0.25–0.52]).

Conclusions

It is essential to explore the factors driving differential insulin pump uptake, in both New Zealand and elsewhere, if all patients are to have equal opportunity to benefit from intensive diabetes management.

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Acknowledgments

We thank Analytical Services at the Ministry of Health for providing the data for this study.

Funding

This research was funded through a Strategic Initiative Award from Health Research South, Dunedin School of Medicine, University of Otago. EM received support through an Otago Medical Research Fund and Kelliher Charitable Trust Summer Scholarship Award. The funders had no role in the design of the study, or in the collection, analysis, or interpretation of the data.

Authors’ contributions

EM contributed to the design of the study, carried out the main analyses, interpreted the findings, and co-wrote the first draft of the manuscript. LP conceived and designed the study, obtained funding, acquired the data, specified the analyses, interpreted the findings, co-wrote the first draft of the manuscript, and was responsible for final editing. DJB provided data management expertise, programmed the study algorithm, derived the analysis dataset, and contributed to critical revision of the manuscript. KJS provided statistical expertise, undertook the logistic regression analyses, contributed to the interpretation of the findings, and contributed to critical revision of the manuscript. BJW conceived the study, contributed to the design, interpreted the findings, and contributed to the first draft and critical revision of the manuscript.

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Correspondence to Lianne Parkin.

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Conflict of interest

BJW received a speaker fee from New Zealand Medical & Scientific Ltd in 2015. All other authors report no conflicts of interest.

Ethical standard

Ethical approval was granted by the University of Otago Human Ethics Committee (Health), reference number D15/268.

Human and animal rights

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed consent

This study was based on anonymised routinely collected data and therefore did not involve contact with patients.

Additional information

Erin McKergow and Lianne Parkin shared equal authorship.

Managed by Massimo Federici.

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Cite this article

McKergow, E., Parkin, L., Barson, D.J. et al. Demographic and regional disparities in insulin pump utilization in a setting of universal funding: a New Zealand nationwide study. Acta Diabetol 54, 63–71 (2017). https://doi.org/10.1007/s00592-016-0912-7

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Keywords

  • Insulin pump
  • Utilization
  • Epidemiology
  • Ethnicity
  • Socioeconomic position