Diabetes
Social factors and diabetes follow-up visits after screening in Japan: a cohort study based on the JPHC-NEXT study Miho Hara* Miho Hara Atsushi Goto Kouichi Tamura Yuki Arakawa Tanno Kozo Nobuyuki Takanashi Kazumasa Yamagishi Isao Muraki Nobufumi Yasuda Isao Saito Koutatsu Maruyama Kazuhiko Arima Ayuko Takatani Rieko Kanehara Mariko Hanafusa Taiki Yamaji Motoki Iwasaki Manami Inoue Shoichiro Tsugane Norie Sawada
Objective:
Two-thirds of the patients who were positive for diabetes after screening in Japan missed follow-up visits for diabetes care. We aimed to assess the association between social factors, known to influence physician visits, and diabetes follow-up visits after screening in this population.
Methods:
We conducted a cohort study of adults who were newly found to test positive for diabetes through screening (fasting blood glucose≥126mg/dL or HbA1c≥6.5%), using data on social factors, diabetes-related information, and health screening from a population-based study conducted in seven regions of Japan (2011-2021) and a claims database. A follow-up visit for diabetes care was defined as a consultation with a physician within 6 months of screening. A modified least-squares regression approach was performed to estimate the association between each social factor (education, occupation, income, marital status, and social support) and diabetes follow-up visits, adjusting for gender, age, region, family history of diabetes, and year of health screening.
Results:
Of the 1,965 patients who were positive for diabetes, 885 (45.0%) attended follow-up visits. Education, occupation, income, and marital status were not statistically significantly associated with follow-up visit attendance. However, people with low social support had a lower follow-up rate compared to those with medium to very-high social support (adjusted rates: 40% [95% CI:36–44] for the low social support group; 48% [44–53] for medium; 48% [42–53] for high; 45% [41–48] for very-high). The rate difference between the low social support group and the combined non-low social support groups was 6.6% [1.5–11.7].
Conclusion:
In this population-based cohort study in Japan, factors such as education, occupation, or income appear to have a limited impact on follow-up visits. However, social support may be important for increasing the rate of follow-up visits among those who were positive for diabetes through screening.