Socioeconomic inequalities and diabetes complications: An analysis of administrative data from Hungary

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Background. Diabetes complications are associated with increased healthcare costs and worsened patient outcomes. In this paper we analyze how individual-level demographic and territorial-level socioeconomic and healthcare variables influence the presence and severity of diabetes complications and their relationship with mortality. Methods. Our study utilizes anonymized administrative data from Hungary, containing outpatient and inpatient records of all diabetes patients between 2010 to 2017. We construct settlement-year level and individual-year level panel datasets to analyze diabetes prevalence, incidence and complications, employing Poisson and logit models to explore associations between complications and the explanatory variables. The adapted Diabetes Complications Severity Index (aDCSI) is employed to quantitatively evaluate the severity of complications by aggregating individual complication scores from ICD-10 diagnosis codes. Results. Diabetes prevalence and incidence are higher in settlements with above-median unemployment rates, where patients exhibit more severe complications, as shown by higher average aDCSI scores. Among socioeconomic factors, unemployment rate is particularly associated with increased aDCSI scores, while better healthcare access is associated with lower aDCSI scores in unadjusted but with higher scores in adjusted models. The presence and severity of complications, especially renal, cardio-vascular and peripheral vascular ones, substantially increase five-year inpatient mortality. Most of the mortality difference by settlement-level unemployment rate disappears when complications are accounted for. Conclusions. Territorial-level socioeconomic disparities, especially elevated unemployment rates, significantly exacerbate the severity of diabetes complications, which subsequently heightens the mortality risk among diabetic patients. Enhancing health-care access in lower socioeconomic regions may alleviate these disparities and lessen the impact of complications.