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Educational attainment affects the diagnostic time in type 2 diabetes mellitus and the mortality risk of those enrolled in the diabetes pay-for-performance program

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  • Liao, Yi-Shu
  • Tsai, Wen-Chen
  • Chiu, Li-Ting
  • Kung, Pei-Tseng

Abstract

Most patients are diagnosed as having diabetes only after experiencing diabetes complications. Educational attainment might have a positive relationship with diabetes prognosis. The diabetes pay-for-performance (P4P) program—providing comprehensive, continuous medical care—has improved diabetes prognosis in Taiwan. This retrospective cohort study investigated how educational attainment affects the presence of diabetes complications at diabetes diagnosis and mortality risk in patients with diabetes enrolled in the P4P program. From the National Health Insurance Research Database, we identified patients aged >45 years who had received a new diagnosis of type 2 diabetes during 2002–2015; they were followed up until the end of 2017. We next used logistic regression analysis to explore whether the patients with different educational attainments had varied diabetic complication risks at diabetes diagnosis. The Cox proportional hazard model was employed to examine the association of different educational attainments in people with diabetes with mortality risk after their enrollment in the P4P program. The results indicated that as educational attainment increased, the risk of diabetes complications at type 2 diabetes diagnosis decreased gradually. When type 2 diabetes with different educational attainments joined the P4P program, high school education had the highest effect on reducing mortality risk; however, those with ≤ 6th grade education had the lowest impact.

Suggested Citation

  • Liao, Yi-Shu & Tsai, Wen-Chen & Chiu, Li-Ting & Kung, Pei-Tseng, 2023. "Educational attainment affects the diagnostic time in type 2 diabetes mellitus and the mortality risk of those enrolled in the diabetes pay-for-performance program," Health Policy, Elsevier, vol. 138(C).
    • Handle: RePEc:eee:hepoli:v:138:y:2023:i:c:s0168851023002026
    DOI: 10.1016/j.healthpol.2023.104917
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    References listed on IDEAS

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    1. Kim, Hongsoo & Cheng, Shou-Hsia, 2018. "Assessing quality of primary diabetes care in South Korea and Taiwan using avoidable hospitalizations," Health Policy, Elsevier, vol. 122(11), pages 1222-1231.
    2. Rodríguez-Sánchez, Beatriz & Cantarero-Prieto, David, 2019. "Socioeconomic differences in the associations between diabetes and hospital admission and mortality among older adults in Europe," Economics & Human Biology, Elsevier, vol. 33(C), pages 89-100.
    3. Hui-Ting Huang & Yu-Ming Kuo & Shiang-Ru Wang & Chia-Fen Wang & Chung-Hung Tsai, 2016. "Structural Factors Affecting Health Examination Behavioral Intention," IJERPH, MDPI, vol. 13(4), pages 1-15, April.
    4. Hsiu-Ling Huang & Chuan-Yu Kung & Shun-Mu Wang & Pei-Tseng Kung & Yen-Hsiung Lin & Li-Ting Chiu & Wen-Chen Tsai, 2021. "Effects of Body Mass Index and Pay-for-Performance Program on Risk of Death in Patients with Type 2 Diabetes: A Nationwide Cohort Study," IJERPH, MDPI, vol. 18(9), pages 1-16, April.
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