scholarly journals Differences in U.S. Rural-Urban Trends in Diabetes ABCS, 1999–2018

2021 ◽  
Author(s):  
Carla I. Mercado ◽  
Kai McKeever Bullard ◽  
Edward W. Gregg ◽  
Mohammed K. Ali ◽  
Sharon H. Saydah ◽  
...  
Keyword(s):  
Rural Areas ◽  
Clinical Characteristics ◽  
Diabetes Management ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Clinical Aspects ◽  
Race Ethnicity ◽  
Cholesterol Control ◽  
Lood Pressure ◽  
Diagnosed Diabetes

<p><u>Objective</u>: To examine changes and the relationships between rural-urban residence and diabetes management. </p> <p><u>Research Design and Methods</u>: Using National Health and Nutrition Examination Survey (1999-2018) data from 6,372 adults aged ≥18 years with self-reported diagnosed diabetes, we examined poor ABCS as <b>A</b>1c >9% [>75 mmol/mol], <b>B</b>lood pressure (BP) ≥140/90 mmHg, <b>C</b>holesterol (non-HDL) ≥160 mg/dL [≥4.1 mmol/L], and current <b>S</b>moking. We compared odds of urban vs rural residents (census tract population size ≥2500 considered urban, otherwise rural) with poor ABCS across time (1999-2006, 2007-2012, and 2013-2018), overall and by sociodemographic and clinical characteristics. </p> <p><u>Results</u>: Over 1999-2018, the proportion of U.S. adults with diabetes residing in rural areas ranged between 15% to 19.5%. In 1999-2006, there were no statistically significant rural-urban differences in poor ABCS. However, from 1999-2006 to 2013-2018, there were greater improvements for urban adults with diabetes than rural for BP≥140/90mmHg (relative OR: 0.8, 0.6-0.9) and non-HDL≥160mg/dL (≥4.1mmol/L) (relative OR: 0.6, 0.4-0.9). These differences remained statistically significant after adjusting for race/ethnicity, education, poverty levels, and clinical characteristics. Yet, over the 1999-2018 time period, minority race/ethnicity, lower education attainment, poverty, and lack of health insurance coverage were factors associated with poorer A, B, C, or S in urban compared to rural counterparts.</p> <p><u>Conclusions</u>: Over two decades, rural U.S. adults with diabetes have had less improvements in BP and cholesterol control. In addition, rural-urban differences exist across sociodemographic groups, suggesting that efforts to narrow this divide may need to address both socioeconomic and clinical aspects of care.</p>

scholarly journals Differences in U.S. Rural-Urban Trends in Diabetes ABCS, 1999–2018

2021 ◽  
Author(s):  
Carla I. Mercado ◽  
Kai McKeever Bullard ◽  
Edward W. Gregg ◽  
Mohammed K. Ali ◽  
Sharon H. Saydah ◽  
...  
Keyword(s):  
Rural Areas ◽  
Clinical Characteristics ◽  
Diabetes Management ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Clinical Aspects ◽  
Race Ethnicity ◽  
Cholesterol Control ◽  
Lood Pressure ◽  
Diagnosed Diabetes

<p><u>Objective</u>: To examine changes and the relationships between rural-urban residence and diabetes management. </p> <p><u>Research Design and Methods</u>: Using National Health and Nutrition Examination Survey (1999-2018) data from 6,372 adults aged ≥18 years with self-reported diagnosed diabetes, we examined poor ABCS as <b>A</b>1c >9% [>75 mmol/mol], <b>B</b>lood pressure (BP) ≥140/90 mmHg, <b>C</b>holesterol (non-HDL) ≥160 mg/dL [≥4.1 mmol/L], and current <b>S</b>moking. We compared odds of urban vs rural residents (census tract population size ≥2500 considered urban, otherwise rural) with poor ABCS across time (1999-2006, 2007-2012, and 2013-2018), overall and by sociodemographic and clinical characteristics. </p> <p><u>Results</u>: Over 1999-2018, the proportion of U.S. adults with diabetes residing in rural areas ranged between 15% to 19.5%. In 1999-2006, there were no statistically significant rural-urban differences in poor ABCS. However, from 1999-2006 to 2013-2018, there were greater improvements for urban adults with diabetes than rural for BP≥140/90mmHg (relative OR: 0.8, 0.6-0.9) and non-HDL≥160mg/dL (≥4.1mmol/L) (relative OR: 0.6, 0.4-0.9). These differences remained statistically significant after adjusting for race/ethnicity, education, poverty levels, and clinical characteristics. Yet, over the 1999-2018 time period, minority race/ethnicity, lower education attainment, poverty, and lack of health insurance coverage were factors associated with poorer A, B, C, or S in urban compared to rural counterparts.</p> <p><u>Conclusions</u>: Over two decades, rural U.S. adults with diabetes have had less improvements in BP and cholesterol control. In addition, rural-urban differences exist across sociodemographic groups, suggesting that efforts to narrow this divide may need to address both socioeconomic and clinical aspects of care.</p>

scholarly journals 2193 The influence of health insurance stability on racial/ethnic differences in diabetes control and management

2018 ◽  
Vol 2 (S1) ◽  
pp. 74-75
Author(s):  
Alison G. M. Brown ◽  
Nancy R. Kressin ◽  
Norma Terrin ◽  
Amresh Hanchate ◽  
Jillian Suzukida ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Care Policy ◽  
Diabetes Management ◽  
Insurance Coverage ◽  
Ethnically Diverse ◽  
Health Insurance Coverage ◽  
Policy Debate ◽  
Race Ethnicity ◽  
The Impact ◽  
Racial Ethnic

OBJECTIVES/SPECIFIC AIMS: The aim of this study is to examine if stable health insurance coverage is associated with improved type 2 diabetes (DM) control and with reduced racial/ethnic health disparities. METHODS/STUDY POPULATION: We utilized EMR data (2005–2013) from 2 large, urban academic health centers with a racially/ethnically diverse patient population to longitudinally examine insurance coverage, and diabetes outcomes (A1C, LDL cholesterol, BP) and management measures (e.g., A1C and BP monitoring). We categorized insurance stability status during each 6-month interval as 6 separate categories based upon type (private, public, uninsured) and continuity of insurance (continuous, switches, or gaps in coverage). We will examine the association between insurance stability status and DM outcomes adjusting for time, age, sex, comorbidities, site of care, education, and income. Additional analysis will examine if insurance stability moderates the impact of race/ethnicity on DM outcomes. RESULTS/ANTICIPATED RESULTS: Overall, we anticipate that stable health insurance coverage will improve measures for DM care, particularly for racially/ethnically diverse patients. DISCUSSION/SIGNIFICANCE OF IMPACT: The finding of an interaction between insurance stability status and race/ethnicity in improved diabetes management and control would inform the national health care policy debate on the impact of stable health insurance.

scholarly journals The convergence of racial and income disparities in health insurance coverage in the United States

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
De-Chih Lee ◽  
Hailun Liang ◽  
Leiyu Shi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Combined Effect ◽  
Medical Expenditure ◽  
The Us ◽  
Race Ethnicity ◽  
Vulnerability Measure

Abstract Objective This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. Data source The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. Study design Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. Data collection/extraction methods We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. Principal findings While income was a significant predictor of health insurance coverage (a difference of 6.1–7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. Conclusion Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.

The impact of health insurance coverage on pediatric diabetes management

2010 ◽  
Vol 90 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Kupper A. Wintergerst ◽  
Krystal M. Hinkle ◽  
Christopher N. Barnes ◽  
Adetokunbo O. Omoruyi ◽  
Michael B. Foster
Keyword(s):  
Health Insurance ◽  
Diabetes Management ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Pediatric Diabetes ◽  
The Impact

scholarly journals Challenges with Pain Treatment for Rural Older Adults: Family Caregivers' Views

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 893-894
Author(s):  
Hyunjin Noh ◽  
Cho Rong Won ◽  
Zainab Suntai
Keyword(s):  
Older Adults ◽  
Health Insurance ◽  
Family Caregivers ◽  
Rural Areas ◽  
Pain Treatment ◽  
Financial Burden ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Thinking Skills ◽  
Rural Older Adults

Abstract Family caregivers face various challenges in assisting older adults experiencing pain and difficult symptoms. Living in rural areas poses additional obstacles to their caregiving. The purpose of this study was to explore family caregivers’ lived experiences in caring for older adults with pain and discomfort in rural communities. A qualitative research design was adopted to capture the common essence of participants’ experiences through a phenomenological method. Purposeful sampling was used, and the participant criteria was: age 18+, have good thinking skills, resident of Alabama, provide unpaid assistance to a family/relative who has chronic/serious health conditions and experienced pain/discomfort in the last 3 months. Ten participants were recruited from rural counties of Alabama. Individual semi-structured interviews were conducted via phone and were recorded and transcribed verbatim. Inductive, thematic analysis of the data revealed themes in five categories: 1) impact of pain (physical and psychological/emotional toll), 2) coping strategies (faith/contentment with life/logistical adaptation), 3) impact of Covid-19 (physical health/social interaction/mental health/added caregiving), 4) challenges in pain treatment (transportation (time/distance/driver/cost) and non-transportation related problems (healthcare provider issues/health insurance/financial burden)), and 5) suggestions (transportation-related (more transportation options/tailored services) and non-transportation-related support (home-based services/better health insurance coverage)). Findings of this study highlight rural family caregivers’ unique experiences in assisting older adults’ access to pain treatment, particularly during the Covid-19 pandemic. Policy- and program-level intervention is called for to increase individualized transportation options, improve health insurance coverage, and expand financial support for rural older adults experiencing pain and their caregivers.

scholarly journals Association Between Health Insurance and Race With Mortality From Trauma: a Retrospective Study

2021 ◽  
Author(s):  
Ibrahim Gwarzo ◽  
Maria Perez-Patron ◽  
Xiaohui Xu ◽  
Tiffany Radcliff ◽  
Jennifer Horney
Keyword(s):  
Health Insurance ◽  
Trauma Registry ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Registry Data ◽  
Insurance Status ◽  
Health Insurance Status ◽  
Trauma Mortality ◽  
Race Ethnicity ◽  
Related Mortality

Abstract Background: The population health implications of the growing burden of trauma-related mortality may be influenced by access to health insurance coverage, and demographic characteristics such as race and ethnicity. We investigated the effects of health insurance status and race/ethnicity on the risk of mortality among trauma victims in Texas.Methods: Using Texas trauma registry data from 2014 - 2016, we categorized health insurance coverage into private, public, and uninsured, and categorized patients with serious injuries into Non-Hispanic Whites, Non-Hispanic Blacks, Hispanics Any-Race, and Others. Multivariate logistic regression was used to estimate the effects of health insurance status and race/ethnicity on mortality, controlling for age, gender, severity of the trauma, cause of trauma, presence of comorbid conditions, trauma center designation, presence of a traumatic brain injury (TBI), and severity of a TBI. Results: From January 1, 2014, to December 31, 2016, there were 415,159 trauma cases in Texas; 8,827 (2.1%) were fatal. Among patients with at least a moderate injury, 24, 606 (17.4%) were uninsured, and 98, 237 (69.4%) identified as Non-Hispanic White. In the multivariate analysis, Hispanics of any race and Non-Hispanic Blacks had higher adjusted odds of trauma mortality compared to Non-Hispanic Whites [ORHispanics= 1.25: 95% CI (1.16 – 1.36)] [ORBlacks= 2.11: 95% CI (1.87 – 2.37)]. Similarly, compared to privately insured, uninsured patients had 86% higher odds of trauma-related death [OR= 1.86: 95% CI (1.66 – 2.05)]. The effects of lack of health insurance on trauma mortality varied across race/ethnicity of the victims; uninsured Non-Hispanic Blacks had disproportionately higher adjusted odds of trauma mortality than uninsured Whites. Conclusion: Using Texas trauma registry data, we found significant disparities in trauma-related mortality risk based on race/ethnicity and health insurance coverage. The identification of trauma mortality inequalities could inform the design and implementation of future public health interventions.

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