Investigating the role of healthcare accessibility and socio-economic background on the decision to attend for screening for gestational diabetes mellitus in Ireland

Hdl Handle:
http://hdl.handle.net/10147/238852
Title:
Investigating the role of healthcare accessibility and socio-economic background on the decision to attend for screening for gestational diabetes mellitus in Ireland
Authors:
Owens, L; Cullinane, J; Gillespie, P; Avalos, G; O'Sullivan, EP; O'Reilly, M; Dennedy, C; Dunne, F
Affiliation:
Department of Medicine, National University of Ireland, Galway 2Department of Economics, National University of Ireland, Galway
Publisher:
Diabetic Pregnancy Study Group
Issue Date:
2011
URI:
http://hdl.handle.net/10147/238852
Abstract:
Gestational diabetes mellitus (GDM) is associated with increased maternal and neonatal morbidity and mortality. We investigated the role of healthcare centre accessibility on the decision to attend for screening, employing geographic information systems (GIS), econometric and simulation techniques. In particular, we focus on the extent to which ‘travel distance to screening site’ impacts upon the individual’s screen uptake decision, whether significant geographic inequalities exist in relation to accessibility to screening, and the likely impact on uptake rates of providing screening services at a local level. We also aimed to assess whether Irish women of lower socio-economic status were less likely to attend for screening for Diabetes in Pregnancy than their higher status counterparts. This study was completed through the Atlantic Diabetes in Pregnancy (DIP) partnership, which offers universal screening for Gestational Diabetes at 24-28 weeks gestation. Data was collected on all women who delivered in 5 antenatal centres along the Irish Atlantic Seaboard between 2007-2009. Patients were ‘geocoded’, in order to provide precise spatial (x,y) coordinates for their residential locations. This facilitates geographic information systems -based route analysis of travel distances for each individual to their nearest screening site. We then model the decision to attend for screening, where control variables include travel distance to screening site, a range of other site accessibilityrelated variables, as well as a number of individual-level variables relating to personal, socioeconomic, clinical and lifestyle characteristics. The socio-economic status is based on the deprivation score derived from the 2006 Census of Population for the Republic of Ireland. The Deprivation Index is constructed from a combination of various indicators; education, employment, percentage skilled/unskilled workers, demographic information, lone parents and number of persons/room. 9,043 pregnant women offered screening, 5,218 (58%) of whom participated in testing. The probability of attending for screening was reduced by 1.8% [95% CI: 1.3% to 2.3%] for every additional 10kms required to travel for screening (p=0.000). We also find significant variation in uptake rates across hospitals after controlling for travel distance and other factors, suggesting that accessibility and quality-of-service are also important determinants of overall uptake rates. Using the deprivation index 60% of those who scored 1 (most affluent) attended for screening, 58% in score 2, 56% in score 3, 53% in score 4 and 46% in the score 5 (most deprived) group attended, p=0.0001. This shows a clear decrease in attendance levels in those who are deemed to be more disadvantaged. The most disadvantaged women overall were 40% less likely to attend than their most affluent counterparts (OR0.6, 95%CI {0.55-0.71},p=0.001). Accessibility to healthcare centres and socio-economic background both affect the decision to attend for screening for Gestational Diabetes Mellitus in Ireland.
Item Type:
Conference Poster
Language:
en
Keywords:
SCREENING; PREGNANCY; DIABETES

Full metadata record

DC FieldValue Language
dc.contributor.authorOwens, Len_GB
dc.contributor.authorCullinane, Jen_GB
dc.contributor.authorGillespie, Pen_GB
dc.contributor.authorAvalos, Gen_GB
dc.contributor.authorO'Sullivan, EPen_GB
dc.contributor.authorO'Reilly, Men_GB
dc.contributor.authorDennedy, Cen_GB
dc.contributor.authorDunne, Fen_GB
dc.date.accessioned2012-08-15T15:13:16Z-
dc.date.available2012-08-15T15:13:16Z-
dc.date.issued2011-
dc.identifier.urihttp://hdl.handle.net/10147/238852-
dc.description.abstractGestational diabetes mellitus (GDM) is associated with increased maternal and neonatal morbidity and mortality. We investigated the role of healthcare centre accessibility on the decision to attend for screening, employing geographic information systems (GIS), econometric and simulation techniques. In particular, we focus on the extent to which ‘travel distance to screening site’ impacts upon the individual’s screen uptake decision, whether significant geographic inequalities exist in relation to accessibility to screening, and the likely impact on uptake rates of providing screening services at a local level. We also aimed to assess whether Irish women of lower socio-economic status were less likely to attend for screening for Diabetes in Pregnancy than their higher status counterparts. This study was completed through the Atlantic Diabetes in Pregnancy (DIP) partnership, which offers universal screening for Gestational Diabetes at 24-28 weeks gestation. Data was collected on all women who delivered in 5 antenatal centres along the Irish Atlantic Seaboard between 2007-2009. Patients were ‘geocoded’, in order to provide precise spatial (x,y) coordinates for their residential locations. This facilitates geographic information systems -based route analysis of travel distances for each individual to their nearest screening site. We then model the decision to attend for screening, where control variables include travel distance to screening site, a range of other site accessibilityrelated variables, as well as a number of individual-level variables relating to personal, socioeconomic, clinical and lifestyle characteristics. The socio-economic status is based on the deprivation score derived from the 2006 Census of Population for the Republic of Ireland. The Deprivation Index is constructed from a combination of various indicators; education, employment, percentage skilled/unskilled workers, demographic information, lone parents and number of persons/room. 9,043 pregnant women offered screening, 5,218 (58%) of whom participated in testing. The probability of attending for screening was reduced by 1.8% [95% CI: 1.3% to 2.3%] for every additional 10kms required to travel for screening (p=0.000). We also find significant variation in uptake rates across hospitals after controlling for travel distance and other factors, suggesting that accessibility and quality-of-service are also important determinants of overall uptake rates. Using the deprivation index 60% of those who scored 1 (most affluent) attended for screening, 58% in score 2, 56% in score 3, 53% in score 4 and 46% in the score 5 (most deprived) group attended, p=0.0001. This shows a clear decrease in attendance levels in those who are deemed to be more disadvantaged. The most disadvantaged women overall were 40% less likely to attend than their most affluent counterparts (OR0.6, 95%CI {0.55-0.71},p=0.001). Accessibility to healthcare centres and socio-economic background both affect the decision to attend for screening for Gestational Diabetes Mellitus in Ireland.en_GB
dc.language.isoenen
dc.publisherDiabetic Pregnancy Study Groupen_GB
dc.subjectSCREENINGen_GB
dc.subjectPREGNANCYen_GB
dc.subjectDIABETESen_GB
dc.titleInvestigating the role of healthcare accessibility and socio-economic background on the decision to attend for screening for gestational diabetes mellitus in Irelanden_GB
dc.typeConference Posteren
dc.contributor.departmentDepartment of Medicine, National University of Ireland, Galway 2Department of Economics, National University of Ireland, Galwayen_GB
dc.description.provinceConnachten
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