Social Inequality in Childhood Diabetes—A Population-Based Follow-up Study in Germany

To the Editor .— In the January 2002 issue of Pediatrics , Keenan et al1 reported a higher prevalence of ketoacidosis and more prolonged hospitalization in diabetic children and adolescents with low socioeconomic status in the United States. They suggest intensive programs for this patient group to improve their health and potentially to decrease total health care costs. Actually, reduction of social inequality in health is one of the main targets in Europe, too. Because there is a widespread health care system with free entrance for everybody in Germany, it is often argued that social inequality should be less pronounced compared with other countries. However, for children and adolescents with diabetes, only little population-based data about the association between socioeconomic status and health outcomes is available, in Germany as well as in other countries.2–4 Therefore, we performed a study to analyze the influence of several socioeconomic variables on health care outcomes in childhood diabetes in the first course after onset. The study was based on the population-based incidence study in North Rhine-Westphalia, Germany, part of the EURODIAB ACE network.5 In 1996–1998, a total of 1257 children and adolescents with diabetes onset before the age of 15 were registered. …