Diseguaglianze nei ricoveri evitabili per complicanze del diabete: una revisione sistematica della letteratura con meta-analisi

[Autom. eng. transl.] Introduction: Diabetes is a global problem in Public Health and hospitalizations for its complications are defined as potentially avoidable (PE) in the context of good primary care. The aim of the study is to evaluate inequalities in the appropriateness of the territorial treatment of diabetes by measuring the avoidable hospitalization for complications of diabetes among different socioeconomic groups. Methods: A systematic review of the literature was carried out until March 2015, using Medline and Scopus. The key words were: "preventable", "avoidable", "hospitalization", "disparities", "inequalities", "chronic disease", "diabetes". A meta-analysis of the results was then performed using a random-effects model. Results. The review included 22 scientific papers, for a total of about 11 million hospitalizations, which investigated the relationship between inequalities in different populations (general vs. diabetic cohorts) and PE hospitalizations for diabetes complications. 63% of the articles (14/22) had a cross-sectional design, 37% (8/22) were cohort studies. The inequalities were analyzed for the following variables: gender (18/22, 82%), age (18/22, 82%), ethnicity (12/22, 54.5%), income (12/22, 54.5%), area of residence (5/22, 23%). Because of the high heterogeneity between the studies, a meta-analysis was possible only for ethnicity. The combination of 5 studies confirmed an increased risk in PE hospitalizations for diabetes complications among individuals with a disadvantaged ethnicity (black or other minorities vs. Caucasian whites) in a general population setting with a Relative Risk of 2.54 (IC95%: 1.94-3.33). Conclusions. The inequalities of admissions due to diabetic complications indicate an inequitable offer of primary care that must be addressed with a proactive approach to population medicine program.