Effect of Health Care Access on General Health Related Quality of Life (HRQoL) among Diabetics in the Southern Cone of Latin America

Abstract

Background: Health related quality of life (HRQoL) is an important health outcome measure in diabetics and is influenced by socioeconomic, demographic and disease related factors. Additionally, health care access could affect HRQoL in diabetics. The effect of access to care on HRQoL could be more prominent in people with diabetes than in people without diabetes. However, these associations have been rarely investigated. Especially in the Southern Cone of Latin America, were diabetes is increasing and access to care may be impeded, there is a lack of research regarding this topic. Hence, the aim of this thesis was to enhance knowledge on the effect of health care access in diabetics HRQoL in the Southern Cone of Latin America. Methods: Data of 1025 diabetics and 6064 non-diabetics of the CESCAS I study were analyzed. The physical component summary (PCS-12) and the mental component summary (MCS-12) of the SF-12, a generic instrument to measure HRQoL, were used to determine HRQoL. 4 groups were compared 1) Insured people without barriers to realized access (no problems in accessing health care), 2) Uninsured people without barriers to realized access (no potential, but realized access), 3) Insured people with barriers to realized access (no realized, but potential access) 4) Uninsured people with barriers to realized access (no potential and no realized access). Group differences among diabetics’ characteristics and HRQoL as well as between diabetics and non-diabetics were analyzed using Chi Square test, One Way ANOVA, unadjusted and adjusted two-factorial univariate ANOVA, Welch test, Tukey, Bonfferoni and Games Howell as post hoc tests, when appropriate. The association between HRQoL in the diabetic sample and health care access was adjusted for important covariates using multivariate linear regression. Reasons for barriers to realized access were analyzed descriptively. Results: In diabetics, HRQoL was lowest in the fourth group for both component summary scales and highest in the first group followed by the second and the third group. (p-value < 0.001). In adjusted analyses, HRQoL was associated with a decrease of 2 points for the PCS-12 in the second (p-value 0.014), 4.75 points in the third (p-value 0.007) and 6.13 points in the fourth group (p-value < 0.001) compared to the first group. For the MCS-12, the decrease was 4.82 points for the second (p-value 0.032) and 5.6 points in the fourth group (p-value 0.001) compared to the first group. The decrease of 0.62 points in the second group was not significant (p-value 0.553). Reasons for barriers to realized care included long appointment waiting times and compulsory copayments. Diabetes and access to care significantly predicted lower HRQoL regarding the PCS-12 (p-value < 0.001). The MCS-12 was significantly predicted by access to care (p-value < 0.001), but not by diabetes (p-value 0.349). Diabetes and access to care were not interacting in predicting HRQoL in neither the PCS-12 (p-value 0.853), nor the MCS-12 (p-value 0.425). Discussion and Conclusion: In the Southern Cone of Latin America, impeded health care access is common among diabetics and non-diabetics. Realized health care access seems to play a more important role than health insurance status in determining the physical and mental component of HRQoL in both, diabetic and non-diabetic patients. Diabetes seems to negatively affect the physical, but not the mental component of HRQoL. Interventions should be implemented to overcome especially the barriers to realized health care access in order to enhance HRQoL among diabetics.