1
|
Buis LR, Kim J, Sen A, Chen D, Dawood K, Kadri R, Muladore R, Plegue M, Richardson CR, Djuric Z, McNaughton C, Hutton D, Robert LP, Park SY, Levy P. The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e57863. [PMID: 38941601 PMCID: PMC11245662 DOI: 10.2196/57863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/12/2024] [Accepted: 04/30/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Hypertension is one of the most important cardiovascular disease risk factors and affects >100 million American adults. Hypertension-related health inequities are abundant in Black communities as Black individuals are more likely to use the emergency department (ED) for chronic disease-related ambulatory care, which is strongly linked to lower blood pressure (BP) control, diminished awareness of hypertension, and adverse cardiovascular events. To reduce hypertension-related health disparities, we developed MI-BP, a culturally tailored multibehavior mobile health intervention that targeted behaviors of BP self-monitoring, physical activity, sodium intake, and medication adherence in Black individuals with uncontrolled hypertension recruited from ED and community-based settings. OBJECTIVE We sought to determine the effect of MI-BP on BP as well as secondary outcomes of physical activity, sodium intake, medication adherence, and BP control compared to enhanced usual care control at 1-year follow-up. METHODS We conducted a 1-year, 2-group randomized controlled trial of the MI-BP intervention compared to an enhanced usual care control group where participants aged 25 to 70 years received a BP cuff and hypertension-related educational materials. Participants were recruited from EDs and other community-based settings in Detroit, Michigan, where they were screened for initial eligibility and enrolled. Baseline data collection and randomization occurred approximately 2 and 4 weeks after enrollment to ensure that participants had uncontrolled hypertension and were willing to take part. Data collection visits occurred at 13, 26, 39, and 52 weeks. Outcomes of interest included BP (primary outcome) and physical activity, sodium intake, medication adherence, and BP control (secondary outcomes). RESULTS We obtained consent from and enrolled 869 participants in this study yet ultimately randomized 162 (18.6%) participants. At 1 year, compared to the baseline, both groups showed significant decreases in systolic BP (MI-BP group: 22.5 mm Hg decrease in average systolic BP and P<.001; control group: 24.1 mm Hg decrease and P<.001) adjusted for age and sex, with no significant differences between the groups (time-by-arm interaction: P=.99). Similar patterns where improvements were noted in both groups yet no differences were found between the groups were observed for diastolic BP, physical activity, sodium intake, medication adherence, and BP control. Large dropout rates were observed in both groups (approximately 60%). CONCLUSIONS Overall, participants randomized to both the enhanced usual care control and MI-BP conditions experienced significant improvements in BP and other outcomes; however, differences between groups were not detected, speaking to the general benefit of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations. High dropout rates were found and are likely to be expected when working with similar populations. Future work is needed to better understand engagement with mobile health interventions, particularly in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT02955537; https://clinicaltrials.gov/study/NCT02955537. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/12601.
Collapse
Affiliation(s)
- Lorraine R Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Junhan Kim
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Dongru Chen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Katee Dawood
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Reema Kadri
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Rachelle Muladore
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Melissa Plegue
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Caroline R Richardson
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Family Medicine, Brown University, Providence, RI, United States
| | - Zora Djuric
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Candace McNaughton
- Department of Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - David Hutton
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lionel P Robert
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Sun Young Park
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Phillip Levy
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| |
Collapse
|
2
|
Currà A, Gasbarrone R, Gargiulo P, Rughetti A, Peschillo S, Trompetto C, Puce L, Marinelli L, Fattapposta F, Bragazzi NL, Missori P. Frequency of brain ventricular enlargement among patients with diabetes mellitus. Diabetes Res Clin Pract 2024; 210:111644. [PMID: 38552909 DOI: 10.1016/j.diabres.2024.111644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/01/2024]
Abstract
AIMS To determine the prevalence of dilated ventricles and concomitant high blood glucose measures. METHODS We retrieved blood glucose measures from the emergency department database and selected a subgroup of individuals having both the radiological marker Evans' index (EI) values and blood glucose measures. RESULTS Out of 1221 consecutive patients submitted to axial Computed Tomography scans, a blood glucose measure was detected in 841 individuals. 176 scans (21 %) showed an EI > 0.30. According to the blood glucose categorization, diabetic patients were 104 (12 %), 25 of them (24 %) were dilated (mean EI 0.33). The age difference between dilated and not-dilated ventricles is about ten years in not-diabetic participants, whereas it is five years in diabetic participants. The age difference between dilated and not-dilated ventricles is about 10 years in diabetic men, whereas it zero in diabetic women. CONCLUSIONS Pathological ventricular enlargement is more frequent in men and in the elderly. In diabetic patients (especially women), the cerebral ventricles enlarge faster than in non-diabetic individuals. Age, sex, and diabetes may interact in determining how cerebral ventricle size changes over time, especially in diabetic women, making routine brain imaging advisable in these patients after the age of 70 years.
Collapse
Affiliation(s)
- Antonio Currà
- Academic Neurology Unit, A. Fiorini Hospital, Terracina, LT, Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Italy
| | - Riccardo Gasbarrone
- Department of Chemical Engineering, Materials & Environment, Sapienza University of Rome, Rome, Italy
| | - Patrizia Gargiulo
- Department of Experimental Medicine, Endocrinology-Pituitary Disease, "Sapienza" University of Rome, Rome, Italy
| | - Aurelia Rughetti
- Department of Experimental Medicine, "Sapienza" University of Rome, Italy
| | | | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Italy; Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Italy; Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Francesco Fattapposta
- Department of Human Neuroscience, Neurology, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
| | - Paolo Missori
- Department of Human Neuroscience, Neurosurgery, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
| |
Collapse
|
3
|
Hansotte E, Andrea SB, Weathers TD, Stone C, Jessup A, Staten LK. Impact of community health workers on diabetes management in an urban United States Community with high diabetes burden through the COVID pandemic. Prev Med Rep 2024; 39:102645. [PMID: 38370984 PMCID: PMC10869924 DOI: 10.1016/j.pmedr.2024.102645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024] Open
Abstract
Objective Community Health Worker (CHW) interventions are promising approaches to increasing access to health care, garnering better health outcomes, and decreasing health inequities for historically marginalized populations. This study examines the impact of a health system-based CHW program embedded in the Diabetes Impact Project - Indianapolis Neighborhoods (DIP-IN), a large, place-based, multi-year intervention to reduce diabetes burden. We assessed the CHW program's effectiveness in managing glucose control and reducing diabetes-associated complications across the COVID timeline. Methods We examined the association between the CHW intervention and diabetes management in 454 CHW patients and 1,020 propensity score-matched comparison patients. Using electronic medical records for encounters between January 1, 2017, and March 31, 2022, we estimated the CHW program effect using a difference-in-difference approach through generalized linear mixed models. Results Participation was associated with a significant reduction (-0.54-unit (95 % CI: -0.73, -0.35) in glycosylated hemoglobin (A1C) on average over time that was beyond the change observed among comparison patients, higher odds of having ≥ 2 A1C measures in a year (OR = 2.32, 95 % CI: 1.79, 3.00), lower odds of ED visits (OR: 0.88; 95 % CI: 0.73, 1.05), and lower odds of hospital admission (OR: 0.81; 95 % CI: 0.60,1.09). When analyses were restricted to a pre-pandemic timeframe, the pattern of results were similar. Conclusion This program was effective in improving diabetes management among patients living in diabetes-burdened communities, and the effects were persistent throughout the pandemic timeline. CHW programs offer crucial reinforcement for diabetes management during periods when routine healthcare access is constrained.
Collapse
Affiliation(s)
- Elinor Hansotte
- Marion County Public Health Department, 3838 N. Rural St., Indianapolis, IN 46205, United States
| | - Sarah B. Andrea
- Oregon Health & Science University-Portland State University School of Public Health, Vanport Building, 1810 SW 5 Ave., Suite 510, Portland, OR 97201, United States
| | - Tess D. Weathers
- Indiana University Richard M. Fairbanks School of Public Health, Health Sciences Building, 1050 Wishard Blvd., Indianapolis, IN 46202, United States
| | - Cynthia Stone
- Indiana University Richard M. Fairbanks School of Public Health, Health Sciences Building, 1050 Wishard Blvd., Indianapolis, IN 46202, United States
| | - Alisha Jessup
- Eskenazi Health, 720 Eskenazi Ave., Indianapolis, IN 46202, United States
| | - Lisa K. Staten
- Indiana University Richard M. Fairbanks School of Public Health, Health Sciences Building, 1050 Wishard Blvd., Indianapolis, IN 46202, United States
| |
Collapse
|
4
|
Omoladun-Tijani TA, Vish NL. Family and Neighborhood Resilience Are Associated with Children's Healthcare Utilization. J Pediatr 2023; 261:113543. [PMID: 37290587 DOI: 10.1016/j.jpeds.2023.113543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the association of external factors of resilience, neighborhood, and family resilience with healthcare use. STUDY DESIGN A cross-sectional, observational study was conducted using data from the 2016-2017 National Survey of Children's Health. Children aged 4-17 years were included. Multiple logistic regression was used to determine aOR and 95% CIs for association between levels of family resilience, neighborhood resilience and outcome measures: presence of medical home, and ≥2 emergency department (ED) visits per year while adjusting for adverse childhood experiences (ACEs), chronic conditions, and sociodemographic factors. RESULTS We included 58 336 children aged 4-17 years, representing a population of 57 688 434. Overall, 8.0%, 13.1%, and 78.9% lived in families with low, moderate, and high resilience, respectively; 56.1% identified their neighborhood as resilient. Of these children, 47.5% had a medical home and 4.2% reported ≥2 ED visits in the past year. A child with high family resilience had 60% increased odds of having a medical home (OR, 1.60; 95% CI, 1.37-1.87), and a child with moderate family resilience or resilient neighborhood had a 30% increase (OR, 1.32 [95% CI, 1.10-1.59] and OR, 1.31 [95% CI, 1.20-1.43], respectively). There was no association between resilience factors and ED use, although children with increased ACEs had increased ED use. CONCLUSIONS Children from resilient families and neighborhoods have an increased odds of receiving care in a medical home after adjusting for the effects of ACEs, chronic conditions, and sociodemographic factors, but no association was seen with ED use.
Collapse
Affiliation(s)
| | - Nora L Vish
- Wright State University, Boonshoft School of Medicine, Fairborn; Dayton Children's Hospital, Dayton, OH.
| |
Collapse
|
5
|
Adu DT, Li W, Sawadgo WPM. Estimating the unintended impact of the North American free trade agreement on U.S. public health. Soc Sci Med 2023; 333:116140. [PMID: 37573675 DOI: 10.1016/j.socscimed.2023.116140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/09/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
The North American Free Trade Agreement (NAFTA) was introduced in 1994 between Canada, Mexico, and the United States to encourage trilateral trade. In 2008, an unrestricted reciprocal sugar trade agreement, was implemented between Mexico and the United States as part of NAFTA, which led to a significant decrease in the United States' sugar price. However, critics argue that free trade agreements that reduce trade barriers on products such as sugar threaten public health. This study uses the synthetic control method to investigate the causal impact of the unrestricted sugar trade agreement on sugar consumption and diabetes prevalence in the United States. First, we show that sugar consumption in the United States increased by an average of 16% annually after the agreement was signed, corresponding to 5240g per capita. Second, we show that the crude prevalence of diabetes increased by an average of 1% annually in the United States after the agreement was signed, with an increase of 1% and 2% for men and women, respectively. This unintended consequence of NAFTA has had an estimated economic cost of $324.37 million annually.
Collapse
Affiliation(s)
- Derick T Adu
- Department of Agricultural Economics and Rural Sociology, Auburn University, USA.
| | - Wenying Li
- Department of Agricultural Economics and Rural Sociology, Auburn University, USA.
| | - Wendiam P M Sawadgo
- Department of Agricultural Economics and Rural Sociology, Auburn University, USA
| |
Collapse
|
6
|
Chehal PK, Uppal TS, Ng BP, Alva M, Ali MK. Trends and Race/Ethnic Disparities in Diabetes-Related Hospital Use in Medicaid Enrollees: Analyses of Serial Cross-sectional State Data, 2008-2017. J Gen Intern Med 2023; 38:2279-2288. [PMID: 36385411 PMCID: PMC10406763 DOI: 10.1007/s11606-022-07842-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Race/ethnic disparities in preventable diabetes-specific hospital care may exist among adults with diabetes who have Medicaid coverage. OBJECTIVE To examine race/ethnic disparities in utilization of preventable hospital care by adult Medicaid enrollees with diabetes across nine states over time. DESIGN Using serial cross-sectional state discharge records for emergency department (ED) visits and inpatient (IP) hospitalizations from the Healthcare Cost and Utilization Project, we quantified race/ethnicity-specific, state-year preventable diabetes-specific hospital utilization. PARTICIPANTS Non-Hispanic Black, non-Hispanic White, and Hispanic adult Medicaid enrollees aged 18-64 with a diabetes diagnosis (excluding gestational or secondary diabetes) who were discharged from hospital care in Arizona, Iowa, Kentucky, Florida, Maryland, New Jersey, New York, North Carolina, and Utah for the years 2008, 2011, 2014, and 2017. MAIN MEASURES Non-Hispanic Black-over-White and Hispanic-over-White rate ratios constructed using age- standardized state-year, race/ethnicity-specific ED, and IP diabetes-specific utilization rates. KEY RESULTS The ratio of Black-over-White ED utilization rates for preventable diabetes-specific hospital care increased across the 9 states in our sample from 1.4 (CI 95, 1.31-1.50) in 2008 to 1.73 (CI 95, 1.68-1.78) in 2017. The cross-year-state average non-Hispanic Black-over-White IP rate ratio was 1.46 (CI 95, 1.42-1.50), reflecting increases in some states and decreases in others. The across-state-year average Hispanic-over-White rate ratio for ED utilization was 0.67 (CI 95, 0.63-0.71). The across-state-year average Hispanic-over-White IP hospitalization rate ratio was 0.72 (CI 95, 0.69-0.75). CONCLUSIONS Hospital utilization by non-Hispanic Black Medicaid enrollees with diabetes was consistently greater and often increased relative to utilization by White enrollees within state programs between 2008 and 2017. Hispanic enrollee hospital utilization was either lower or indistinguishable relative to White enrollee hospital utilization in most states, but Hispanic utilization increased faster than White utilization in some states. Among broader patterns, there is heterogeneity in the magnitude of race/ethnic disparities in hospital utilization trends across states.
Collapse
Affiliation(s)
- Puneet Kaur Chehal
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA.
| | - Tegveer S Uppal
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Boon Peng Ng
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - Maria Alva
- Massive Data Institute, McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
7
|
Lavin R, Couig MP, Kelley PW, Schwarts T, Ramos F. Healthcare Impacts Associated with Federally Declared Disasters-Hurricanes Gustave and Ike. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5388. [PMID: 37048001 PMCID: PMC10094278 DOI: 10.3390/ijerph20075388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
People impacted by disasters may have adverse non-communicable disease health effects associated with the disaster. This research examined the independent and joint impacts of federally declared disasters on the diagnosis of hypertension (HTN), diabetes (DM), anxiety, and medication changes 6 months before and after a disaster. Patients seen in zip codes that received a federal disaster declaration for Hurricanes Gustave or Ike in 2008 and who had electronic health records captured by MarketScan® were analyzed. The analysis included patients seen 6 months before or after Hurricanes Gustav and Ike in 2008 and who were diagnosed with HTN, DM, or anxiety. There was a statistically significant association between post-disaster and diagnosis of hypertension, X2 (1, n = 19,328) = 3.985, p = 0.04. There was no association post-disaster and diabetes X2 (1, n = 19,328) = 0.778, p = 0.378 or anxiety, X2 (1, n = 19,328) = 0.017, p = 0.898. The research showed that there was a change in the diagnosis of HTN after a disaster. Changes in HTN are an additional important consideration for clinicians in disaster-prone areas. Data about non-communicable diseases help healthcare disaster planners to include primary care needs and providers in the plans to prevent the long-term health impacts of disasters and expedite recovery efforts.
Collapse
Affiliation(s)
- Roberta Lavin
- College of Nursing, University of New Mexico, Albuquerque, NM 87131, USA
| | - Mary Pat Couig
- College of Nursing, University of New Mexico, Albuquerque, NM 87131, USA
| | | | - Thais Schwarts
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, NM 87131, USA
| | - Fermin Ramos
- College of Nursing, University of New Mexico, Albuquerque, NM 87131, USA
| |
Collapse
|
8
|
Ryan JL, Franklin SM, Canterberry M, Long CL, Bowe A, Roy BD, Hessler D, Aceves B, Gottlieb LM. Association of Health-Related Social Needs With Quality and Utilization Outcomes in a Medicare Advantage Population With Diabetes. JAMA Netw Open 2023; 6:e239316. [PMID: 37083665 PMCID: PMC10122170 DOI: 10.1001/jamanetworkopen.2023.9316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Importance Recent research highlights the association of social determinants of health with health outcomes of patients with type 2 diabetes (T2D). Objective To examine associations between health-related social needs (HRSNs) and health care quality and utilization outcomes in a Medicare Advantage population with T2D. Design, Setting, and Participants This cross-sectional study used medical and pharmacy claims data from 2019. An HRSN survey was given between October 16, 2019, and February 29, 2020, to Medicare Advantage beneficiaries. Inclusion criteria were diagnosis of T2D, age of 20 to 89 years, continuous Medicare Advantage enrollment in 2019, and response to the HRSN survey. Data were analyzed between June 2021 and January 2022. Exposures Enrollment in Medicare Advantage, diagnosis of T2D, and completion of a survey on HRSNs. Main Outcomes and Measures Quality outcomes included diabetes medication adherence, statin adherence, completion of a glycated hemoglobin (HbA1c) laboratory test in the past 12 months, and controlled HbA1c. Utilization outcomes included all-cause hospitalization, potentially avoidable hospitalization, emergency department discharge, and readmission. Results Of the 21 528 Medicare Advantage beneficiaries with T2D included in the study (mean [SD] age, 71.0 [8.3] years; 55.4% women), most (56.9%) had at least 1 HRSN. Among the population with T2D reporting HRSNs, the most prevalent were financial strain (73.6%), food insecurity (47.5%), and poor housing quality (39.1%). In adjusted models, loneliness (odds ratio [OR], 0.85; 95% CI, 0.73-0.99), lack of transportation (OR, 0.80; 95% CI, 0.69-0.92), utility insecurity (OR, 0.86; 95% CI, 0.76-0.98), and housing insecurity (OR, 0.78; 95% CI, 0.67-0.91) were each associated with lower diabetes medication adherence. Loneliness and lack of transportation were associated with increased emergency visits (marginal effects of 173.0 [95% CI, 74.2-271.9] and 244.6 [95% CI, 150.4-338.9] emergency visits per 1000 beneficiaries for loneliness and transportation, respectively). Food insecurity was the HRSN most consistently associated with higher acute care utilization (marginal effects of 84.6 [95% CI, 19.8-149.4] emergency visits, 30.4 [95% CI, 9.5-51.3] inpatient encounters, and 17.1 [95% CI, 4.7-29.5] avoidable hospitalizations per 1000 beneficiaries). Conclusions and Relevance In this cross-sectional study of Medicare Advantage beneficiaries with T2D, some HRSNs were associated with care quality and utilization. The results of the study may be used to direct interventions to the social needs most associated with T2D health outcomes and inform policy decisions at the insurance plan and community level.
Collapse
Affiliation(s)
| | | | | | | | - Andy Bowe
- Humana Healthcare Research, Louisville, Kentucky
| | | | - Danielle Hessler
- Social Interventions Research & Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
| | - Benjamin Aceves
- School of Public Health, San Diego State University, San Diego, California
| | - Laura M Gottlieb
- Social Interventions Research & Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
| |
Collapse
|
9
|
Kobo O, Van Spall HGC, Mamas MA. Urban-rural disparities in diabetes-related mortality in the USA 1999-2019. Diabetologia 2022; 65:2078-2083. [PMID: 36085381 PMCID: PMC9630196 DOI: 10.1007/s00125-022-05785-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/15/2022] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Our study aimed to examine the trends in diabetes-related mortality in urban and rural areas in the USA over the past two decades. METHODS We examined the trends in diabetes-related mortality (as the underlying or a contributing cause of death) in urban and rural areas in the USA between 1999 and 2019, using the CDC WONDER Multiple Cause of Death database. We estimated the 20 year trends of the age-adjusted mortality rate (AAMR) per 100,000 population in urban vs rural counties. RESULTS The AAMR of diabetes was higher in rural than urban areas across all subgroups. In urban areas, there was a significant decrease in the AAMR of diabetes as the underlying (-16.7%) and contributing (-13.5%) cause of death (ptrend<0.001), which was not observed in rural areas (+2.6%, +8.9%, respectively). AAMRs of diabetes decreased more significantly in female compared with male individuals, both in rural and urban areas. Among people younger than 55 years old, there was a temporal increase in diabetes-related AAMR (+13.8% to +65.2%). While the diabetes-related AAMRs of American Indian patients decreased in all areas (-19.8% to -40.5%, all ptrend<0.001), diabetes-related AAMRs of Black and White patients decreased significantly in urban (-26.6% to -28.3% and -10.7% to -15.4%, respectively, all ptrend<0.001) but not rural areas (-6.5% to +1.8%, +2.4% to +10.6%, respectively, ptrend NS, NS, NS and <0.001). CONCLUSIONS/INTERPRETATION The temporal decrease in diabetes-related mortality in the USA has been observed only in urban areas, and mainly among female and older patients. A synchronised effort is needed to improve cardiovascular health indices and healthcare access in rural areas and to decrease diabetes-related mortality.
Collapse
Affiliation(s)
- Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera, Israel
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
- Research Institute of St Joseph's, Hamilton, ON, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
- Department of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA.
- Institute of Population Health, University of Manchester, Manchester, UK.
| |
Collapse
|