Diabetes complications are associated with increased healthcare costs and worsened
patient outcomes. In this paper, we analyse how individual-level demographic and territorial-level
socioeconomic and healthcare variables influence the presence and severity of diabetes
complications and their relationship with mortality. Our study utilizes anonymized
administrative healthcare data on all diabetes patients of Hungary between 2010 and
2017. We construct settlement-year level and individual-year level panel datasets
to analyse diabetes prevalence, incidence and complications, employing Poisson and
logit models to explore associations between complications and the explanatory variables.
The adapted Diabetes Complications Severity Index (aDCSI) is employed to quantitatively
evaluate the severity of complications by aggregating individual complication scores
from ICD-10 diagnosis codes. We find that diabetes prevalence and incidence are higher
in settlements with above-median unemployment rates, where patients exhibit more severe
complications, as shown by higher average aDCSI scores. Among socioeconomic factors,
unemployment rate is particularly associated with increased aDCSI scores, while better
healthcare access is associated with lower aDCSI scores in unadjusted but with higher
scores in adjusted models. The presence and severity of complications, especially
renal, cardiovascular and peripheral vascular ones, substantially increase 5-year
inpatient mortality. Most of the mortality difference by settlement-level unemployment
rate disappears when complications are accounted for. We conclude that socioeconomic
inequalities, particularly higher unemployment rates, are strongly linked to diabetes
complications and associated mortality risk. Addressing these disparities through
improved healthcare accessibility and targeted public health strategies could play
a crucial role in reducing the burden of diabetes-related complications and improving
patient outcomes.
