Hippisley-Cox et al have reported evidence of sex inequalities in access to care for diabetes in primary care in the UK.1 We are undertaking a national study of the factors that influence the care of patients with diabetes in Tunisian primary care health centres, including a retrospective medical review of over 2000 patients from 48 centres. Our results suggest that sex inequalities in the care of patients with diabetes are international.
In our study,2 women with diabetes attending health centres are significantly younger than men, less likely to have type 1 diabetes, less educated, less likely to be working, less likely to be smokers and to drink alcohol and more likely to have cardiovascular disease. Women also have significantly higher levels of systolic and diastolic blood pressure, total cholesterol and body mass index but lower mean creatinine levels than men. These findings were all to be expected. However, Table 1 shows a selection of other data related to access of care suggesting significant differences between the care of men and women. Women are more likely to attend their appointment on time, but the time until their next given appointment is significantly longer. Women are also less likely to have their care recorded in the new disease-specific medical records. This is important, as we have shown that use of these records is associated with improved quality of care.3
Table 1.
Differences between the care of men and women.
| Factor | Men (n = 841) | Women (n = 1319) | P-valuea |
|---|---|---|---|
| Mean age (years) | 58.01 | 60.88 | <0.001 |
| Number of visits in preceding 12 months | 3.65 | 3.75 | 0.07 |
| Mean time until next appointment (days) | 81.62 | 84.58 | 0.033 |
| Consultations >2 weeks late (%) | 27.7 | 23.3 | 0.082 |
| New records used (%) | 89.3 | 84.8 | 0.08 |
| Completion of new records (score of 12 variables) | 7.11 ± 4.22 | 6.68 ± 4.27 | 0.014 |
P-value using logistic regression with sex as the dependent variable and the factor in question plus age and health centre entered as the explanatory variables.
Sex inequalities in the care of patients with diabetes in primary care are not limited to the UK. We sincerely agree that further work is required to confirm, and if possible, explain these findings, and to seek ways of correcting these inequalities.
REFERENCES
- 1.Hippisley-Cox J, Yates J, Pringle M, et al. Sex inequalities in access to care for patients with diabetes in primary care: questionnaire survey. Br J Gen Pract. 2006;56:342–348. [PMC free article] [PubMed] [Google Scholar]
- 2.Bouguerra R, Alberti H, Ben Salem L, et al. The global diabetes pandemic: the Tunisian experience. Eur J Clin Nutr. doi: 10.1038/sj.ejcn.1602478. in press. [DOI] [PubMed] [Google Scholar]
- 3.Alberti H, Boudriga N, Nabli M. Disease-specific medical records improve the recording of processes of care in the management of type 2 diabetes mellitus. Public Health. doi: 10.1016/j.puhe.2005.05.011. in press. [DOI] [PubMed] [Google Scholar]