Dynamics of healthcare inequalities in type 2 diabetes mellitus across the COVID-19 pandemic: a real-world population-based study.

backgroundhealthcare inequalities have been widely documented, yet the COVID-19 pandemic may have altered their magnitude and direction. This study aimed to analyse the dynamics of healthcare inequalities in patients with type 2 diabetes mellitus (T2DM) before and after the pandemic using a real-world data approach.

methodswe conducted a real-world observational study including T2DM patients aged ≥ 45 from the CARhES cohort, a population-based dataset integrating clinical and administrative information from Aragón (Spain), between 2017 and 2022. Healthcare utilisation was assessed at two levels: Primary Care and specialist care. Socioeconomic, clinical, and healthcare variables were retrieved from electronic health records. We described healthcare utilisation patterns and trends across the study period and estimated adjusted prevalence ratios (PRs) for inequality axes (age, gender, migrant status, socioeconomic level, and rurality) using Poisson regression models at three time points (2017, 2020, 2022), adjusting for multimorbidity.

resultsA total of 86,407 T2DM patients were included. Almost all patients consulted a general practitioner (GP) each year and increased over time, while specialist consultations declined during the pandemic and had not recovered by 2022. Socioeconomic inequalities persisted or widened across most axes. After the pandemic, patients aged ≥ 80 were less likely to visit GP than younger patients, reversing pre-pandemic trends. Women continued to show higher GP use than men but fewer consulted with specialist, although the magnitude of the observed difference was small. Immigrants' access to specialists decreased relative to natives in 2022. active people with low socioeconomic status showed the lowest specialist consultations, while mutualists had the highest during the pandemic. Rural residents maintained greater reliance on Primary Care but fewer specialist visits post-pandemic. The explanatory power of socioeconomic variables declined in GP models, whereas multimorbidity gained influence during and after COVID-19.

conclusionsHealthcare inequalities among T2DM patients persisted and some patterns shifted after 2020. Although GP utilisation increased, nursing and specialist follow-up did not recover to pre-pandemic levels. These patterns underscore the need for targeted interventions to optimise care for older adults, women, migrants, rural residents, and low-income populations, with a focus on promoting digital inclusion and developing tailored healthcare pathways to advance health equity.