Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Rates of attainment of high-quality diabetes care have been shown to be lower for those living in more disadvantaged and rural areas. Diabetes management relies on access to care and is impacted by physical, social, and economic factors. Area deprivation index (ADI) is one way to quantify geographic disparities in aggregate. We aimed to investigate how ADI impacts outcomes in members with type 2 diabetes enrolled in a large, regional health plan. OBJECTIVE: To evalute clinical and economic objectives. Clinical objectives included the percentage of members who achieved hemoglobin A1c (A1c) goal level of 7% or less, the percentage of members who received comorbidity-focused therapies, noninsulin diabetes medication adherence, and the frequency and type of health care services used. Economic outcomes included per member per month differences in total cost of care, pharmacy cost, medical cost, and diabetes-associated cost. METHODS: This retrospective review of pharmacy and medical claims included 8,814 adult members with newly diagnosed type 2 diabetes enrolled in an integrated health plan during calendar year 2021. To be included, members were required to be at least 18 years of age, reside in Pennsylvania, and have continuous enrollment for 2 years prior to type 2 diabetes diagnosis. State-level ADI data were derived for each member and applied to the Census block group on file in the administrative claims data. The study population deciles were grouped into ADI quintiles for analysis. Multivariable regression models and descriptive statistics were used to evaluate the association between ADI and outcomes while controlling for confounding variables. RESULTS: < 0.01). CONCLUSIONS: Significant differences were identified between ADI quintiles 1 and 5 for noninsulin diabetes medication adherence, frequency of A1c test claims, all-cause health care service utilization, and total cost of care. There were no statistically significant differences between ADI quintiles for achievement of A1c goal or receipt of comorbidity-focused therapies.
Authors: Taylor N. Laffey, David Marr, Ashley Modany, Molly McGraw, Tavvy Mounarath, Andrew Bryk, Nicholas Christian, Chester Good
Institution: UPMC Health System
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W4404850132