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Evans E, Jacobs M. Diabetes and Financial Well-Being: Differential Hardship Among Vulnerable Populations. Sci Diabetes Self Manag Care 2024; 50:263-274. [PMID: 38853573 DOI: 10.1177/26350106241256324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
PURPOSE The purpose of the study was to examine financial well-being among a diverse population of individuals with and without diabetes. METHODS Data from the Understanding America Survey, a nationally representative, longitudinal panel, were utilized to identify adults with self-reported diabetes diagnoses between 2014 and 2020. We used longitudinal mixed effects regression models to assess the association between diabetes and financial well-being score (FWBS) among racial and ethnic population subgroups. Models included sex, age, marital status, household size, income, education, race/ethnicity, insurance, body mass index, employment, and health insurance, incorporating individual- and household-level fixed effects. Racial and ethnic differentials were captured using group-condition interactions. RESULTS Black participants (17.06%) had the highest prevalence of diabetes, followed by White participants (12.2%), "other" racial groups (10.7%), and Hispanic participants (10.0%). In contrast, White participants (M = 67.66, SD = 22.63) and other racial groups (M = 67.99, SD = 18.45) had the highest FWBSs, followed by Hispanic participants (M = 59.31, SD = 22.78) and Black participants (M = 55.86, SD = 25.67). Compared to White participants, Black participants (β = -5.49, SE = 0.71) and Hispanic participants (β = -2.06, SE = 0.63) have significantly lower FWBSs. Compared to males, females (β = -3.25, SE = 0.41) had lower FWBSs among individuals with diabetes. FWBSs of individuals with diabetes was 2.71 points lower (SE = 0.52), on average, than those without diabetes. Education, household size, age, marital status, and income were also significantly associated with FWBSs. CONCLUSIONS Findings suggest potential disparities in the financial ramifications of diabetes among socially marginalized populations.
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Affiliation(s)
- Elizabeth Evans
- Communication Equity and Outcomes Laboratory, Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Molly Jacobs
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
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Wang N, Nurmagambetov T. Sociodemographic Factors of Asthma Prevalence and Costs Among Children and Adolescents in the United States, 2016-2021. Prev Chronic Dis 2024; 21:E54. [PMID: 39052508 PMCID: PMC11318947 DOI: 10.5888/pcd21.230449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Introduction Asthma is a chronic condition with a high prevalence and cost of care among children and adolescents. While previous research described the association of sociodemographic factors with childhood asthma prevalence, there is limited knowledge of these factors' association with medical expenditures. In this study, we examined disparities in treated asthma prevalence and medical expenditures among US children and adolescents. Methods Using nationally representative data from the 2016-2021 Medical Expenditures Panel Survey, we conducted a cross-sectional study of 2,365 children and adolescents (aged 0-17 y) with treated asthma compared with 40,497 children and adolescents without treated asthma. Treated asthma was defined as whether the child or adolescent had a medical event (emergency department visit, hospital inpatient stay, hospital outpatient visit, office-based medical visit, home health, and/or prescribed medicines) due to asthma. We controlled for sociodemographic factors of race and ethnicity, age, sex, health insurance coverage, family poverty status, and census region. We used 2-part models and generalized linear models to estimate annual per-person incremental medical expenditures associated with asthma. Results Children and adolescents with treated asthma were more likely than those without treated asthma to be non-Hispanic Black or Hispanic, male, and publicly insured. Children and adolescents with treated asthma had $3,362.56 in additional annual medical expenditures, of which $174.06 was out-of-pocket, compared with children and adolescents without treated asthma. The additional expenditures included $955.96 for prescribed medicines, $151.52 for emergency department visits, and $858.17 for office-based medical visits. Non-Hispanic Black children with treated asthma had significantly lower total ($2,721.28) and office-based visit expenditures ($803.19) than non-Hispanic White children with treated asthma. Conclusion Disparities among children and adolescents in the US persist in treated asthma prevalence and associated medical expenditures by sociodemographic factors.
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Affiliation(s)
- Nianyang Wang
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Health Science and Practice, Asthma and Air Quality Branch, 4770 Buford Hwy, S106-6, Atlanta, GA 30341
| | - Tursynbek Nurmagambetov
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Health Science and Practice, Asthma and Air Quality Branch, Atlanta, Georgia
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Benites-Meza JK, Pinedo-Castillo L, Cabanillas-Lazo M, Herrera-Añazco P, Mougenot B, Benites-Zapata VA. Ethnic disparities in out-of-pocket expense on medicines in Peru: Evidence from a nationwide survey. PUBLIC HEALTH IN PRACTICE 2023; 6:100442. [PMID: 38028258 PMCID: PMC10651671 DOI: 10.1016/j.puhip.2023.100442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background Despite improvements in health insurance coverage, out-of-pocket (OOP) health spending remains a public health issue in Peru, and OOP payment has implications for disease treatment in ethnic minorities. We aimed to analyze the ethnic disparities in the OOP payment and estimate the gaps related to observable risk factors in the OOP payment on medicines by ethnic conditions during 2014-2016 in Peru. Study design cross-sectional study. Methods We conducted a secondary data analysis using the National Health User Satisfaction Survey. The outcome was the participants' OOP payment in self-reported medications. Ethnic minorities were considered participants who habitually spoke a language other than Spanish at home. Crude and adjusted linear regression models were performed, and the Oaxaca-Blinder decomposition method was used to assess the OPP payment differential by ethnic minority condition, explained by their individual and sociodemographic characteristics. Results We analyzed 11,346 surveyed, the mean age was 40.78 years, and 57.67 % were women. There was lower OOP payment in medications among ethnic minorities in the adjusted analysis (Beta coefficient [β]: -0.11; 95 % confidence interval [95%CI]: -0.21 to -0.01; p = 0.043). In the Oaxaca-Blinder decomposition analysis, a gap of 0.19 USD in the OOP payment in medicines among ethnic minorities was found (p < 0.001), and the explained component by the variables measured in this research only represents 40.5 % of the gap (p = 0.001). Conclusion There was less OOP expenditure on medicines in ethnic minorities. However, the measured variables explain only 40.5 % of these gaps. Therefore, we recommend future research that measures other variables that explain aspects of OOP spending on medicines not identified in this research. Likewise, our findings can be used to establish policies with an intercultural approach that adapt health documents to native languages or are disseminated by trained people from their communities.
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Affiliation(s)
- Jerry K. Benites-Meza
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Liseth Pinedo-Castillo
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Chiclayo, Peru
| | - Miguel Cabanillas-Lazo
- Sociedad Científica de San Fernando, Lima, Peru
- Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Benoit Mougenot
- Facultad de Ciencias Empresariales, Universidad San Ignacio de Loyola, Lima, Peru
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Vicente A. Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
- Red Internacional en Salud Colectiva y Salud Intercultural, Mexico City, Mexico
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Kwon S, Ha JH, Kim DK, Kim YS, Lim CS, Chang H, Lee JP, Park J. Revisiting metformin therapy for the mitigation of diabetic foot ulcer in patients with diabetic kidney disease from real-world evidence. Int Wound J 2023; 21:e14370. [PMID: 37740678 PMCID: PMC10824619 DOI: 10.1111/iwj.14370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/25/2023] Open
Abstract
Diabetic foot ulcer and diabetic kidney disease are diabetes-related chronic vascular complications that strongly correlate with high morbidity and mortality. Although metformin potentially confers a wound-healing advantage, no well-established clinical evidence supports the benefit of metformin for diabetic foot ulcer. Thus, this study investigated the effect of metformin on diabetic foot ulcer from a large diabetic kidney disease cohort for the first time. This retrospective cohort study enrolled 10 832 patients who visited the nephrology department more than twice at two South Korean tertiary-referral centers between 2001 and 2016. The primary outcome was diabetic foot ulcer events; secondary outcomes included hospitalization, amputation, a composite of amputation or vascular intervention, and Wagner Grade ≥ 3. Multivariate Cox analysis and propensity score matching (PSM) were used to balance baseline intergroup differences between metformin users and non-users. In total, 4748 patients were metformin users, and 6084 patients were metformin non-users. Over a follow-up period of 117.5 ± 66.9 months, the diabetic foot ulcer incidence was 5.2%. After PSM, metformin users showed a lower incidence of diabetic foot ulcer events than metformin non-users (adjusted hazard ratio 0.41; p < 0.001). In a sensitivity analysis of 563 patients with diabetic foot ulcer, metformin usage was associated with lower severity in all four secondary outcomes: hospitalization (adjusted hazard ratio 0.33; p < 0.001); amputation (adjusted hazard ratio 0.44; p = 0.001); composite of amputation or vascular intervention (adjusted hazard ratio 0.47; p < 0.001); and Wagner Grade ≥ 3 (adjusted hazard ratio 0.39; p < 0.001). In conclusion, metformin therapy in patients with diabetic kidney disease can lower diabetic foot ulcer incidence and progression.
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Affiliation(s)
- Soie Kwon
- Department of Internal MedicineChung‐Ang University Heuk‐Seok HospitalSeoulRepublic of Korea
- Department of Clinical Medical SciencesCollege of Medicine, Seoul National UniversitySeoulRepublic of Korea
| | - Jeong Hyun Ha
- Department of Plastic and Reconstructive SurgerySeoul National University HospitalSeoulRepublic of Korea
- Department of Plastic and Reconstructive SurgerySeoul National University Boramae Medical CenterSeoulRepublic of Korea
| | - Dong Ki Kim
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
- Department of Internal MedicineSeoul National University, College of MedicineSeoulRepublic of Korea
| | - Yon Su Kim
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
- Department of Internal MedicineSeoul National University, College of MedicineSeoulRepublic of Korea
| | - Chun Soo Lim
- Department of Internal MedicineSeoul National University, College of MedicineSeoulRepublic of Korea
- Department of Internal MedicineSeoul National University Boramae Medical CenterSeoulRepublic of Korea
| | - Hak Chang
- Department of Plastic and Reconstructive SurgerySeoul National University HospitalSeoulRepublic of Korea
- Department of Plastic and Reconstructive SurgerySeoul National University College of MedicineSeoulRepublic of Korea
| | - Jung Pyo Lee
- Department of Internal MedicineSeoul National University, College of MedicineSeoulRepublic of Korea
- Department of Internal MedicineSeoul National University Boramae Medical CenterSeoulRepublic of Korea
| | - Ji‐Ung Park
- Department of Plastic and Reconstructive SurgerySeoul National University Boramae Medical CenterSeoulRepublic of Korea
- Department of Plastic and Reconstructive SurgerySeoul National University College of MedicineSeoulRepublic of Korea
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Provider Network Structure and Black-to-White Disparity Gaps for Medicare Patients with Diabetes: County-Level Analysis of Cost, Utilization, and Clinical Care. J Gen Intern Med 2022; 37:753-760. [PMID: 34236601 PMCID: PMC8904690 DOI: 10.1007/s11606-021-06975-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prior work has shown that provider network structures correlate with outcomes such as patient costs, utilization, and care. However, it remains unknown whether certain provider networks are associated with reduced disparity gaps. METHODS We study the population of Medicare beneficiaries with diabetes who were continuously enrolled in Medicare FFS in 2016. Using multivariable regression analysis of county-level risk adjusted cost, hospitalization, emergency department visits, A1c testing, and preventable diabetes-related hospitalizations, we measure the effect that the relative network connectivity of primary care providers (PCPs) in relation to medical and surgical specialists (PCP/Specialist degree centrality ratio), derived from Medicare patient sharing data, has on non-Hispanic black-to-white disparity gaps controlling for county-level socioeconomic and demographic variables and state fixed effects. RESULTS Relative to non-Hispanic white, our adjusted results show that non-Hispanic black beneficiaries have $1673 (p<0.001) higher risk adjusted total costs, 2.6 (p<0.001) more hospitalizations (per 1000 beneficiaries), 11.6 (p<0.001) more ED visits (per 1000 beneficiaries), receive 2.2% (p<0.001) less A1c testing, and have 69.4 (p<0.01) more (per 100,000) avoidable diabetes-related hospital admissions. Our main results show that increasing the PCP/Specialist degree centrality ratio by one standard deviation is associated with a disparity gap decrease of 25.3% (p<0.01) in hospitalizations, 8.3% (p<0.05) in ED visits, 2.8% (p<0.01) in A1c testing, and 26.9% (p<0.1) in the volume of preventable diabetes-related hospital admissions. CONCLUSIONS Network structures where PCPs are more central relative to medical and surgical specialists are associated with reduced non-Hispanic black-to-white disparity gaps, suggesting that how we organize and structure our health systems has implications for disparity gaps between non-Hispanic black and white Medicare beneficiaries with diabetes.
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Gliedt JA, Walker RJ, Lu K, Dawson AZ, Egede LE. The Relationship Between Patient Satisfaction and Healthcare Expenditures in Adults with Spine Related Disorders: An Analysis of the 2008 to 2015 Medical Expenditures Panel Survey (MEPS). Spine (Phila Pa 1976) 2021; 46:1409-1417. [PMID: 33826590 PMCID: PMC8463412 DOI: 10.1097/brs.0000000000004047] [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] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE The aim of this study was to investigate the relationship between patient satisfaction (PS) and healthcare expenditures (HCE) in adults with spine related disorders (SRDs). SUMMARY OF BACKGROUND DATA SRDs are widespread and pose a high cost to society. PS and HCE have yet to be studied in this population. METHODS Fifteen thousand eight hundred fifty adults with SRDs from the Medical Expenditures Panel Survey (MEPS) (2008-2015) were analyzed. The MEPS medical conditions files were used to identify SRDs based on International Classification of Diseases-9 codes. Frequencies and percentages of sample demographics were calculated. HCE was measured as total direct payments for care provided during the survey year. A composite PS score was constructed using a 0 to 10 rating of their healthcare providers combined with the frequency in which patients felt they were listened to, were given understandable explanations, were respected, and were given enough time. Mean unadjusted HCE were calculated for each year and by quartile of PS. A two-part model consisting of a probit model and subsequent generalized linear model with gamma distribution was performed, adjusting for relevant covariates. Margins command was used to calculate incremental estimates of HCE. RESULTS Mean unadjusted HCE increased annually from $7057 (95% confidence interval [CI], $6516, $7597) in 2008 to $9820 (95% CI, $8811, $10,830) in 2015 for adults with SRDs. Adjusting for predisposing factors, individuals in second, third, and fourth quartiles of PS were significantly different from the first quartile. Adjusting for predisposing and enabling factors, only fourth quartile was significantly different from first quartile. After adjusting for predisposing, enabling and need factors, second, third, and fourth quartiles were no longer significantly different from the first quartile. CONCLUSION Expenditures have increased over time in adults with SRDs. PS is significantly associated with expenditures after controlling for predisposing and enabling factors, but not significant after controlling for need factors. Need factors appear to explain the relationship between lower levels of PS and higher HCE in adults with SRDs.Level of Evidence: 2.
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Affiliation(s)
- Jordan A. Gliedt
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kaiwei Lu
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aprill Z. Dawson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Park J, Zhang P, Wang Y, Zhou X, Look KA, Bigman ET. High Out-of-pocket Health Care Cost Burden Among Medicare Beneficiaries With Diabetes, 1999-2017. Diabetes Care 2021; 44:1797-1804. [PMID: 34183427 PMCID: PMC8376067 DOI: 10.2337/dc20-2708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/17/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined the magnitude of and trends in the burden of out-of-pocket (OOP) costs among Medicare beneficiaries age 65 years or older with diabetes overall, by income level, by race/ethnicity, and compared with beneficiaries without diabetes. RESEARCH DESIGN AND METHODS Using data from the 1999-2017 Medicare Current Beneficiary Survey, we estimated average annual per capita OOP costs and percentage of beneficiaries experiencing high OOP burden, defined as OOP costs >10% or >20% of household income. We used joinpoint regression to examine the trends and generalized linear model and logistic regression for comparisons between beneficiaries with and without diabetes. Cost and income estimates were adjusted to 2017 USD. RESULTS Total OOP costs were $3,609-$5,283, with significant increases until 2005 followed by a leveling off. The prevalence of high OOP burden was 57%-72% at the 10% income threshold and 29%-41% at the 20% threshold, with significant increasing trends until 2003 followed by decreases. Total OOP costs were the highest in the ≥75% income quartile, whereas prevalence of high OOP burden was highest in the <25% and 25-50% income quartiles. Non-Hispanic Whites had the highest OOP costs and prevalence of high OOP burden. Beneficiaries with diabetes had significantly higher OOP costs ($498, P < 0.01) and were more likely to have high OOP burden than those without diabetes (odds ratios 1.32 and 1.25 at >10% and >20% thresholds, respectively, P < 0.01). CONCLUSIONS Over the past two decades, Medicare beneficiaries age 65 years or older with diabetes have faced substantial OOP burden, with large income-related disparities.
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Affiliation(s)
- Joohyun Park
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yu Wang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xilin Zhou
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kevin A Look
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI
| | - Elizabeth T Bigman
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Parking Meters to Touch Screens: The Unforeseen Barriers that Expansion of Telemedicine Presents to the Disability Community. Am J Phys Med Rehabil 2021; 100:1105-1108. [PMID: 33871431 DOI: 10.1097/phm.0000000000001771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Over 25% of annual health care expenditures in the United States are associated with the medical needs of people with disabilities. People with disabilities often experience inequalities with access to healthcare services, resulting in increased costs of living with disability. The economic burden of living with a disability results in nearly $400 billion spent annually from combined public and private payor sources. Historically, disparities in healthcare are associated with intersections between race, culture, and environmental factors. Minority status also plays a significant role in health outcomes and studies have highlighted the additional burdens faced at the junction of race and disability status. COVID-19 changed the landscape of healthcare delivery in the United States, resulting in a drastic increase in telehealth utilization. Traditional non-medical barriers to persons with disability, such as unforeseen parking fees, are documented in the literature. However, conditions surrounding access to the necessary technology required to participate in a telehealth driven medical landscape are less clear. This paper addresses the non-medical barriers and costs associated with living with a disability and discusses potential solutions in the evolving healthcare system.
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Williams JS, Lu K, Akinboboye O, Olukotun O, Zhou Z, Nagavally S, Egede LE. Trends in Obesity and Medical Expenditure among Women with Diabetes, 2008-2016: Differences by Race/Ethnicity. Ethn Dis 2020; 30:621-628. [PMID: 32989362 PMCID: PMC7518529 DOI: 10.18865/ed.30.4.621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives Diabetes results in $327 billion in medical expenditures annually, while obesity, a risk factor for type 2 diabetes, leads to more than $147 billion in expenditure annually. The aims of this study were: 1) to evaluate racial/ethnic trends in obesity and medical expenditures; and 2) to assess incremental medical expenditures among a nationally representative sample of women with diabetes. Methods Nine years of data (2008-2016) from the Medical Expenditure Panel Survey Full Year Consolidated File (unweighted = 11,755; weighted = 10,685,090) were used. The outcome variable was medical expenditure. The primary independent variable was race/ethnicity defined as non-Hispanic Black (NHB), Hispanic, or non-Hispanic White (NHW). Covariates included age, education, marital status, income, insurance, employment, region, comorbidity, and year. Cochran-Armitage tests determined statistical significance of trends in obesity and mean expenditure. Two-part modeling using Probit and gamma distribution was used to assess incremental medical expenditure. Data were clustered to 2008-2010, 2011-2013, 2014-2016. Results Trends in medical expenditures differed significantly between NHB and NHW women between 2008-2016 (P<.001). Hispanic women paid $1,291 less compared with NHW women, after adjusting for relevant covariates. There were no significant differences in obesity trends from 2008-2016 between NHB (P=.989) or Hispanic women with diabetes (P=.938) compared with NHW women with diabetes. Conclusions These findings suggest the need to further understand the factors associated with differences in trends for medical expenditures between NHB and NHW women with diabetes and incremental medical expenditures in Hispanic women with diabetes compared with NHW women with diabetes.
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Affiliation(s)
- Joni S. Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI
| | - Kaiwei Lu
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI
| | - Olaitan Akinboboye
- Institute of Health and Equity, Department of Public and Community Health, Medical College of Wisconsin, Milwaukee, WI
| | - Oluwatoyin Olukotun
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Sneha Nagavally
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI
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Blasco-Blasco M, Puig-García M, Piay N, Lumbreras B, Hernández-Aguado I, Parker LA. Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review. PLoS One 2020; 15:e0237542. [PMID: 32886663 PMCID: PMC7473520 DOI: 10.1371/journal.pone.0237542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Given that most evidence-based recommendations for managing type 2 diabetes mellitus (T2DM) are generated in high-income settings, significant challenges for their implementation exist in Latin America and the Caribbean region (LAC), where the rates of T2DM and related mortality are increasing. The aim of this study is to identify the facilitators and barriers to successful management of T2DM in LAC, from the perspectives of patients, their families or caregivers, healthcare professionals, and/or other stakeholders. METHODS We conducted a systematic review in MEDLINE, Web of Science, SciELO, and LILACS. We included studies of disease management, prevention of complications and risk factor management. We qualitatively synthesized the verbatim text referring to barriers and/or facilitators of diabetes management according to the Theoretical Domain Framework and described their relative frequencies. FINDINGS We included 60 studies from 1,595 records identified. 54 studies (90%) identified factors related to the environmental context and resources, highlighting the importance of questions related to health care access or lack of resources in the health system, and the environmental context and living conditions of the patients. Issues related to "social influences" (40 studies) and "social/professional role and identity" (37 studies) were also frequently addressed, indicating the negative impact of lack of support from family and friends and clinicians' paternalistic attitude. 25 studies identified patients beliefs as important barriers, identifying issues such as a lack of patients' trust in the effectiveness of the medication and/or the doctor's advice, or preferences for alternative therapies. CONCLUSIONS Successful diabetes management in LAC is highly dependent on factors that are beyond the control of the individual patients. Successful disease control will require emphasis on public policies to reinforce health care access and resources, the promotion of a patient-centred care approach, and health promoting infrastructures at environmental level.
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Affiliation(s)
- Mar Blasco-Blasco
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Marta Puig-García
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Nora Piay
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - Blanca Lumbreras
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lucy Anne Parker
- Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Influence of Microbiota on Diabetic Foot Wound in Comparison with Adjacent Normal Skin Based on the Clinical Features. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7459236. [PMID: 31531366 PMCID: PMC6720033 DOI: 10.1155/2019/7459236] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/22/2019] [Indexed: 01/13/2023]
Abstract
Diabetic foot ulcer (DFU) is a complication experienced by diabetic patients and does not heal well in an altered wound environment. Although diverse microbes in DFU were detected, little is known about their influences on diabetic foot wound (DFW) and the association with the skin microbiota in normal tissue from the same patients according to clinical features. We aimed to analyze the microbiota in normal skin and DFW tissue from the same subject and predict their roles based on clinical features. We analyzed the microbiota in normal skin and DFW tissue from the same subject and compared the associated members of microbiota with clinical parameters. The diversity of skin microbiota was higher than that of DFW tissues, along with compositional differences. In addition, different microbes were associated with clinical features. The proportions of Bacteroidetes, Prevotella, Peptoniphilus, Porphyromonas, and Dialister were higher in the severe groups than of the mild groups, whereas that of Firmicutes was lower in the severe groups. According to wound severity, the microbiota could be related to inflammation, damaging host cell membrane, and pathogenicity through lipopolysaccharide biosynthesis, cellular antigens, and protein digestion metabolism. The predicted DFW microbiota functions according to systemic diabetic status defined by ESRD and HbA1c, differed from those presented by wound severity. Results indicate that the microbiota in normal skin is related to the colonizing microbes in DFW tissue according to clinical features and the different microbes can play important roles in DFW prognosis. This information can be applied to prevent and manage DFW by modulating the microbiota.
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Seligman HK, Berkowitz SA. Aligning Programs and Policies to Support Food Security and Public Health Goals in the United States. Annu Rev Public Health 2019; 40:319-337. [PMID: 30444684 PMCID: PMC6784838 DOI: 10.1146/annurev-publhealth-040218-044132] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Food insecurity affects 1 in 8 US households and has clear implications for population health disparities. We present a person-centered, multilevel framework for understanding how individuals living in food-insecure households cope with inadequate access to food themselves and within their households, communities, and broader food system. Many of these coping strategies can have an adverse impact on health, particularly when the coping strategies are sustained over time; others may be salutary for health. There exist multiple opportunities for aligning programs and policies so that they simultaneously support food security and improved diet quality in the interest of supporting improved health outcomes. Improved access to these programs and policies may reduce the need to rely on individual- and household-level strategies that may have negative implications for health across the life course.
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Affiliation(s)
- Hilary K Seligman
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco, California 94143, USA
- The UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California 94110, USA;
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina 27599-7590, USA;
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