The role of socio-economic factors on prevalence and health outcomes of persons with diabetes in Rome, Italy

Background: We investigated the role of socio-economic status on diabetes prevalence, on mortality and hospitalization in a large population-based cohort enrolled in Rome, Italy. Methods: Diabetic residents aged >= 35 years in 2007 were identified using multiple data sources. The effect of the deprivation of the area of residence on diabetes prevalence and on mortality and hospitalization (years 2008-10) was investigated by multilevel regression models, both among diabetic and non-diabetic populations. Results: Prevalence of diabetes (8.3%) was directly related to the deprivation of the area of residence, especially for women. Diabetes increased the risk of mortality and hospitalization, mainly for cardiovascular complications, compared with non-diabetic subjects, with increasing relative risks in more deprived areas. The social gradients observed among diabetic patients are modest compared with non-diabetic subjects, both for some acute complications (myocardial infarction, stroke) and chronic complications (ischaemic heart disease, nephropathy, retinopathy and amputation). Conclusions: Prevalence of diabetes is directly related to deprivation, especially for women. Diabetes increases the risk of mortality and hospitalization for cardiovascular complications. However, similar to another study conducted in Northern Italy, we found that social differences in health outcomes do not differ between people with and without diabetes, suggesting that the care for diabetic patients living in Rome is provided without social disparities, and in some cases, it protects against the adverse effects of social inequalities. The Italian care system for diabetes deserves to be further investigated, as it could represent a model for the care of other chronic conditions and for contrasting social inequities in health.