Socioeconomic Disparity in the Effect of SARS-CoV-2 on Outpatient Visits among People with Type 2 Diabetes in Taiwan

Socioeconomic Disparity in the Effect of SARS-CoV-2 on Outpatient Visits among People with Type 2 Diabetes in Taiwan

Kuan-Hung Liu,^1,2 Teng-Lung Kuo,³ Nai-Ying Ko,^3,4 Yi-Heng Li,⁵ Wen-Chien Ko,⁶ Santi Martini⁷ and Chung-Yi Li^3,7,8,9

¹Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
²Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
³Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
⁴Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
⁵Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
⁶Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
⁷Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia
⁸Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
⁹Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak posed impact on healthcare. This study evaluated the effect of SARS-CoV-2 outbreak on the outpatient visits of patients with type 2 diabetes and determined the most affected groups. We analyzed Taiwan's National Health Insurance data, including 1,922,702 patients diagnosed with type 2 diabetes from 2018 to 2021. Group-based trajectory modelling identified four distinct outpatient visit patterns, namely, consistently high (Group 1, 74.2%), low-to-high (Group 2, 8.1%), high-to-low (Group 3, 6.0%) and consistently low (Group 4, 11.7%) utilization. Logistic regression was used to analyze correlations between trajectory types and patients' demographics and health statuses. Group 3 members had higher odds of being male [adjusted odds ratio (aOR) = 1.04, 95% confidence interval (CI) 1.03-1.05] and earning below 20,000 New Taiwan Dollar monthly (aOR = 1.29, 95% CI 1.26-1.31) than those in Group 1. However, they were less likely to be under 80 years old (aOR = 0.70-0.97), from lower median family income regions (aOR = 0.81-0.89) or possess a Charlson Comorbidity Index score > 2 (aOR = 0.67, 95% CI 0.66-0.68). Patients with lower income in affluent areas displayed the highest likelihood of falling into Group 3. Patients with type 2 diabetes and low income from wealthy areas were vulnerable during the pandemic. This result emphasizes the need to target resources and support for this subgroup during such crises.

Key words —— claims analysis; latent class analysis; SARS-CoV-2; socioeconomic disadvantage; type 2 diabetes mellitus

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Tohoku J. Exp. Med., 2024 March, 262(3), 211-220.

Correspondence: Chung-Yi Li, Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan 701, Taiwan.

e-mail: cyli99@mail.ncku.edu.tw