Introduction & Objective: We evaluated associations between marginalization and pump use in the context of a public funding program, and temporal trends in marginalization among new insulin pump program applicants.
Methods: We conducted population-based studies of adults with type 1 diabetes using administrative data. Unadjusted and adjusted logistic regression was used to assess associations between marginalization [determined by postal code using the Ontario Marginalization Index (ON-MARG)] and insulin pump use on March 31, 2021. Unadjusted ordinal logistic regression was used to evaluate association between insulin pump application year (2007-2022) and odds of being in a higher marginalization quintile.
Results: 16,471 (60%) of 27,453 adults used insulin pumps. Higher ON-MARG quintile was associated with lower odds of insulin pump use [adjusted OR 0.44 (0.39-0.48) for lowest vs. highest quintile]. The most marginalized individuals were the smallest proportion of applicants to the insulin pump program between 2007 and 2022 (Figure 1). While narrowing of marginalization distribution occurred from 2007-2010, widening occurred from 2020-2022.
Conclusion: Disparities in pump use persistent even in the context of public funding, and the COVID-19 pandemic may have disproportionately prevented more marginalized individuals initiating pump therapy. Residual barriers to pump use must be addressed.
Figure: Distribution of material resources quintile for all new applicants to ADP by fiscal year for all ages (n=21,002)
Y. Soliman: None. K. Everett: None. R. Shulman: Advisory Panel; Dexcom Canada. Speaker's Bureau; Dexcom Canada. P. Austin: None. L. Lipscombe: Other Relationship; Novo Nordisk Canada Inc. G.L. Booth: None. A. Weisman: None.
Banting Research Foundation & Canadian Statistical Sciences Institute (CANSSI) Ontario Discovery Award
