Diabetes mellitus and inequalities in the equipment and use of information technologies as a socioeconomic determinant of health in Spain

Inequalities in the equipment and use of information and communications technology (ICT) in Spanish households can lead to users being unable to access certain information or to carry out certain procedures. Accessibility to ICT is considered a social determinant of health (SDOH) because it can generate inequalities in access to information and in managing access to health services. In the face of a chronic illness such as diabetes mellitus (DM)-for which a comprehensive approach is complex and its complications have a direct impact on current healthcare systems-all the resources that patients may have are welcome. We aimed to analyze hospitalizations and amputations as direct consequences of DM among the autonomous communities of Spain (ACS) in 2019, along with socioeconomic factors related to health, including inequalities in access to ICT between territories, as well as citizens' interest in online information searches about DM. We used different databases such as that of the Ministerio de Sanidad (Spain's health ministry), Ministerio de Asuntos Económicos y transformación (Ministry of Economic Affairs and Digital Transformation), Google Trends (GT), and the Instituto Nacional de Estadística (Spain's national institute of statistics). We examined the data with R software. We employed a geolocation approach and performed multivariate analysis (specifically factor analysis of mixed data [FAMD]) to evaluate the aggregate interest in health information related to DM in different regions of Spain grounded in online search behavior. The use of FAMD allowed us to adjust the techniques of principal component analysis (PCA) and multiple correspondence analysis (MCA) to detect differences between the direct consequences of DM, citizen's interest in this non-communicable disease, and socioeconomic factors and inequalities in access to ICT in aggregate form between the country's different ACS. The results show how SDOH, such as poverty and education level, are related to the ACS with the highest number of homes that cite the cost of connection or equipment as the reason for not having ICT at home. These regions also have a greater number of hospitalizations due to DM. Given that in Spain, there are certain differences in accessibility in terms of the cost to households, in the case of DM, we take this issue into account from the standpoint of an integral approach by health policies.