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AJPH First Look, published online ahead of print Jul 27, 2006
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American Journal of Public Health, 10.2105/AJPH.2005.067728

Research and Practice

Understanding the Determinants of Health for People With Type 2 Diabetes

Sheri L. Maddigan 1, David H. Feeny 1, Sumit R. Majumdar 2, Karen B. Farris 3, Jeffrey A. Johnson 1*

1 Institute of Health Economics; Department of Public Health Sciences, University of Alberta
2 Institute of Health Economics; Department of Medicine, University of Alberta
3 The University of Iowa

* To whom correspondence should be addressed. E-mail: jeff.johnson{at}ualberta.ca.


  Abstract

Objective. We assessed which of a broad range of determinants of health are most strongly associated with health-related quality of life (HRQL) among people with type 2 diabetes.

Methods. Our analysis included respondents from the Canadian Community Health Survey Cycle 1.1 (2000-2001) who were aged 18 years and older and who were identified as having type 2 diabetes. We used regression analyses to assess the associations between the Health Utilities Index Mark 3 and determinants of health.

Results. Comorbidities had the largest impact on HRQL, with stroke (-0.11; 95% confidence interval [CI] = -0.17, ?0.06) and depression (-0.11; 95% CI = -0.15, ?0.06) being associated with the largest deficits. Large differences in HRQL were observed for 2 markers of socioeconomic status: social assistance (-0.07; 95% CI=-0.12, ?0.03) and food insecurity (-0.07; 95% CI=-0.10, ?0.04). Stress, physical activity, and sense of belonging also were important determinants. Overall, 36% of the variance in the Health Utilities Index Mark 3 was explained.

Conclusion. Social and environmental factors are important, but comorbidities have the largest impact on HRQL among people with type 2 diabetes.

Key Words: Cardiovascular Disease, Diabetes, Mental Health, Socioeconomic Factors, Surveys




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