The association between joblessness and adult working age diabetic oral antidiabetic medication adherence and health services utilization
Year: 2010
Type: article
Study design: Observational Study
Abstract: Background: Chronic disease represents 46% of the global burden of disease and accounts for 59% of the estimated 57 million worldwide deaths.Diabetes represents a global chronic disease epidemic whose current worldwide prevalence of approximately 171 million individuals is projected to rise to 233 million by 2030.Pharmacologic treatment remains central to achieving chronic disease management targeted health outcomes.Chronic disease management represents a costly component of the health care system and adds large expenditures for individuals as well.Diabetics exhibit 2.3 times a formal ICD-9-CM diagnosis for diabetes mellitus aged 24 years through 59 years.The study excluded diabetics prescribed insulin, pregnant women and individuals with a seasonal working status designation.Medication adherence was measured by the proportion of days covered (PDC) using the following formula: [days supply /number of days in the study period] x100 capped at 1.A PDC > = .80was defined as adherent.Descriptive statistics, as well as appropriate multivariate regression analyses, were used to estimate the associations between joblessness and medication adherence and joblessness and health services utilization.Demographic and clinical covariates were included in the models.Ordinary least square regression analysis was used to assess the PDC and logistic regression assessed adherence.Utilization was assessed by a series of multivariate analysis.First, a series of logistic regressions assessed the likelihood of a health services event (ED, hospitalization, outpatient, or office-based) using categorical (0, 1) yes no dependent variables.Secondly, a series of negative binomial regressions were used to assess the number of ED, hospital, outpatient as well as office-based utilizations. Results:2678 subjects (mean age 48.7 years; mean BMI 31.5;mean Enhanced Charlson Comorbidity Index (CCI) .37;42% jobless; 51% female; 63% married; 55.2% had a high school or GED education; 15% Hispanic; 19% Black; and 10% no health insurance, with 50% of the uninsured employed; 34% poor, near poor, or low income; 39% from the Southern US census region; 23% with one or more DM complication) met the study inclusion criteria.Reasons cited for no job included: 72% were waiting to start a new v job; 19% were unable to work due to illness or disability; followed by 3% retired and 3% taking care of home or family.An estimated 55% of the study population were nonadherent (PDC < = .80)to OAD medication.Comparisons between employed vs. jobless, as well as by insurance status showed larger proportions non-adherent to OAD medications.Uninsured individuals and those of Hispanic ethnicity were statistically significantly less adherent to OAD medication.For non-adherent subjects, 19% were jobless.Multivariate regression models assessing PDC and OAD medication adherence , suggest a statistically significant association between joblessness and lower PDC, as well as an increased likelihood of being non-adherent .The results also suggest family size, age, gender, education, comorbidity and total prescription expense as being significantly associated with adherence.Multivariate regression models assessing all cause utilization showed statistically significant associations between joblessness and increased likelihood of all cause ED, hospitalization, and outpatient utilization and increased number of ED, outpatient and office-based utilization.Moreover, joblessness showed a significant association with an increase in both the likelihood and number of ICD-9-CM DM coded office based visits.Collaterally, family size, age, education, gender, Hispanic ethnicity, race, US census region, poverty category, smoking status, as well as comorbidity, body mass index and the presence of one or more DM related complication showed various significant associations with all cause utilization.Whereas for ICD-9-CM DM coded utilization, Hispanic ethnicity, poverty category, race, US census region, comorbidity, body mass index and smoking status showed various statistically significant associations.vi Finally, insurance status, categorized as uninsured, public and private insurance, was a non-significant parameter for all multivariate regression models assessing PDC and adherence as well as most multivariate regression utilization models with the exception of those assessing all cause ED utilization. Conclusions:The results suggest suboptimal OAD medication adherence in adult working age diabetics.Job status, particularly being without work, significantly lowers the PDC and decreases the likelihood of being adherent to an OAD medication regimen.Those of Hispanic ethnic origin were identified as a particularly vulnerable group.There are significant differences between jobless and employed individuals' likelihood and number of all-cause as well as diabetes disease specific related ED, hospital, outpatient, and office-based utilization.This preliminary study highlights employment status, particularly those with no job, as a significant parameter for the adult working age diabetic.Employment status, particularly unemployment, job loss, or joblessness needs further investigation in relation to the diabetic patient population.
Author: Mary Lynn Davis–Ajami
Institution: The Ohio State University
Language: English
Subfield: Family Practice
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2603851987