Introduction of publicly funded pharmacare and socioeconomic disparities in glycemic management in children and youth with type 1 diabetes in Ontario, Canada: a population-based trend analysis

Mohana Giruparajah; Karl Everett; Baiju R. Shah; Peter C. Austin; Shai Fuchs; Rayzel Shulman

doi:10.9778/cmajo.20210214

Article Figures & Tables

Figures

Tables

Download figure
Open in new tab
Download powerpoint
Figure 1:
Predicted hemoglobin A_1c (HbA_1c, %) over time before and during the Ontario Health Insurance Plan (OHIP)+ program (n = 6347). Linear predictions of HbA_1c before OHIP+ (Jan. 1, 2016, to Dec. 31, 2017) and during OHIP+ (Apr. 1, 2018, to Mar. 31, 2019) by deprivation quintile (Q1 = least deprived, Q5 = most deprived).

Tables

Figures

View popup

Table 1:

Baseline characteristics of youth (aged 21 years, 9 months or younger) who had and did not have an insulin claim during coverage by the Ontario Health Insurance Plan (OHIP)+ program (Jan. 1, 2018, to Mar. 31, 2019)

Characteristic	No. (%) of youth^*
Characteristic	Entire cohort n = 9641	At least 1 insulin claim during OHIP+ n = 7041	No insulin claim during OHIP+ n = 2600
Any drug claim during OHIP+	8704 (90.3)	7041 (100.0)	1663 (64.0)
Metformin claim during OHIP+	341 (3.5)	225 (3.2)	116 (4.5)
Age, yr; mean ± SD	14.3 ± 4.7	14.7 ± 4.3	13.2 ± 5.3
Sex, male	5029 (52.2)	3639 (51.7)	1390 (53.5)
Diabetes duration, yr; mean ± SD	7.06 ± 4.25	7.40 ± 4.35	6.13 ± 3.80
Deprivation quintile
1 (Least deprived)	2184 (22.7)	1716 (24.4)	468 (18.0)
2	1985 (20.6)	1478 (21.0)	507 (19.5)
3	1879 (19.5)	1369 (19.4)	510 (19.6)
4	1703 (17.7)	1182 (16.8)	521 (20.0)
5 (Most deprived)	1776 (18.4)	1232 (17.5)	544 (20.9)
Missing	114 (1.2)	64 (0.9)	50 (1.9)
Any drug claim before OHIP+	2988 (31.0)	2466 (35.0)	522 (20.1)

Note: SD = standard deviation.
↵* Unless indicated otherwise.

View popup

Table 2:

Adjusted segmented regression of hemoglobin A_1c before the Ontario Health Insurance Plan (OHIP)+ program began (Jan. 1, 2016, to Dec. 31, 2017) and during OHIP+ (Apr. 1, 2018, to Mar. 31, 2019) to evaluate whether temporal trends changed between time periods (n = 6347 youth; n = 32 802 measurements of hemoglobin A_1c)

Variable	β estimate (95% CI)
Mean HbA_1c on Jan. 1, 2016, by deprivation quintile
Q1 (least deprived)^*	8.4718 (8.3752 to 8.5684)
Q2	8.6783 (8.5693 to 8.7872)
Q3	8.6464 (8.5393 to 8.7535)
Q4	8.8280 (8.7020 to 8.9541)
Q5 (most deprived)	8.9478 (8.8191 to 9.0764)
Slope (change in HbA_1c per 90 d) (before OHIP+)	0.0037 (−0.0033 to 0.0107)
Change in slope from before OHIP+ to after Apr. 1, 2018	−0.0002 (−0.0004 to 0.0000)
Age (centred on 14 yr)	0.0039 (−0.0078 to 0.0157)
Male	−0.0564 (−0.1427 to 0.0300)
Duration of diabetes (centred on 7 yr)	0.0417 (0.0293 to 0.0541)

Note: CI = confidence interval, HbA_1c = hemoglobin A_1c.
↵* Reference category.

View popup

Table 3:

Adjusted segmented regression of hemoglobin A_1c before the Ontario Health Insurance Plan (OHIP)+ program began (Jan. 1, 2016, to Dec. 31, 2017) and during OHIP+ (Apr. 1, 2018, to Mar. 31, 2019) including interaction terms to evaluate if the change in temporal trend of hemoglobin A_1c differed according to socioeconomic status (n = 6347 youth; n = 32 802 measurements of hemoglobin A_1c)

Variable	β estimate (95% CI)
Mean HbA_1c on Jan. 1, 2016, by material deprivation quintile
Q1 (least deprived)	8.5693 (8.4601 to 8.6785)
Q2	8.6765 (8.5486 to 8.8043)
Q3	8.6002 (8.4708 to 8.7296)
Q4	8.8165 (8.6656 to 8.9674)
Q5 (most deprived)	8.8779 (8.7123 to 9.0435)
Before OHIP+ slope (change in HbA_1c per day), by material deprivation quintile
Q1 (least deprived)	−0.0128 (−0.0254 to 0.0002)
Q2	0.0011 (−0.0125 to 0.0147)
Q3	0.0101 (−0.0062 to 0.0264)
Q4	0.0083 (−0.0099 to 0.0264)
Q5 (most deprived)	0.0189 (0.0009 to 0.0387)
Change in slope from before OHIP+ to after Apr. 1, 2018, by material deprivation quintile
Q1 (least deprived)	0.0001 (−0.0003 to 0.0004)
Q2	0.0001 (−0.0003 to 0.0005)
Q3	−0.0002 (−0.0007 to 0.0003)
Q4	−0.0005 (−0.0011 to 0.0001)
Q5 (most deprived)	−0.0007 (−0.0013 to 0.0001)
Difference in mean HbA_1c on Jan. 1, 2016, compared with Q1 (least deprived)
Q2	0.1072 (−0.0491 to 0.2635)
Q3	0.0309 (−0.1284 to 0.1903)
Q4	0.2472 (0.0724 to 0.4221)
Q5 (most deprived)	0.3086 (0.1207 to 0.4965)
Difference in slope before OHIP+, by material deprivation quintile compared with Q1 (least deprived)
Q2	0.0002 (−0.0001 to 0.0004)
Q3	0.0003 (0.000 to 0.0005)
Q4	0.0002 (0.000 to 0.0005)
Q5 (most deprived)	0.0004 (0.0001 to 0.0006)
Change in slope from before OHIP+ to after Apr. 1, 2018, by material deprivation quintile compared with Q1 (least deprived)
Q2	0.0000 (−0.0005 to 0.0006
Q3	−0.0003 (−0.0009 to 0.0004)
Q4	−0.0006 (−0.0012 to 0.0001)
Q5 (most deprived)	−0.0008 (−0.0015 to 0.0001)
Age (centred on 14 yr)	0.0041 (−0.0077 to 0.0158)
Male	−0.0571 (−0.1435 to 0.0292)
Duration of diabetes (centred on 7 yr)	0.0417 (0.0293 to 0.0541)