Small Area Analysis of Diabetes Complications: Opportunities for Targeting Public Health and Health Services Interventions

Abstract

The objective of this paper is to present small area analyses of diabetes complications in Victoria, Australia, and to illustrate their importance for targeting public health and health services interventions. Local government areas in Victoria were aggregated into 32 Primary Care Partnerships (PCP), which are voluntary alliances of primary care providers. The 32 PCP areas were used as the basic geographic units for small area analyses. Admission rates for diabetes complications were age and sex standardised using the direct method and the 1996 Victorian population as the reference. Admission rate ratios were calculated using the Victorian admission rates as the reference. The 95 per cent confidence intervals for the standardised admission rate ratios were based on the Poisson distribution. There was a wide variation (almost fivefold) in admission rates for diabetes complications across the PCP catchments, with the lowest standardised rate ratio of 0.37 and the highest of 1.75. There were 11 PCPs (seven metropolitan, four rural) with admission rate ratios significantly higher than the Victorian average. The seven metropolitan PCPs contributed more than 43% of all admissions and bed days for diabetes complications in Victoria. Small area analyses of diabetes complications are an exciting new development aimed at stimulating an evidence-based dialogue between local area health service providers, planners and policy-makers. The purpose is to provide opportunities to target public health and health services interventions at the local level to improve the management of diabetes complications in the community.