Diabetes in a time of COVID: Understanding impacts of material deprivation and other social factors on direct and indirect pandemic effects in persons with diabetes

Diabetes is an 'ambulatory care sensitive condition' because better clinic follow-up lowers the chances of needing to be hospitalized or of dying. People with lower incomes generally have more difficulty accessing health care. We suspect that the drop in clinic services not related to COVID-19 infection has impacted them the most, making them even more susceptible to diabetes complications, like dangerous high's and low's in sugar levels, heart attacks, and strokes. We will see if this is what is happening and try to figure out what we can do about it. We will use a rich data sources from Statistics Canada, the Quebec Statistical Institute, and the Office of National Statistics in England. These link information about age, sex, and ethnicity with income level, diagnoses from clinic visits and hospitalizations, and death registries. The information does not contain names or addresses. We will use diagnosis information to figure out who has diabetes. We will study information on people between 2016 and 2022, dividing this period into before pandemic and during the pandemic periods. We will use mathematical equations to figure out if living in a lower income neighbourhood (a signal for living with a lower income) is related to more diabetes-related hospitalization and death, whether this is worse during the pandemic, and how this is related to having less than two follow-ups per year and/or working in a job that does not have the flexibility of working from home. We will see if these relationships are different between women and men, and for people from different self-reported ethnocultural backgrounds. We will see if the difference by income level widened during the pandemic and whether it widened more in Canada or England. The policy differences between Canada and England will give us the context to discuss any differences and how these should influence policy going forward, as related to income supports, educational opportunities, and health care access.