Cross-Sectional Associations: Social Risks and Diabetes Care Quality, Outcomes

Gold, Rachel; Kaufmann, Jorge; Gottlieb, Laura M.; Weiner, Saul J.; Hoopes, Megan; Gemelas, Jordan; Torres, Cristina Huebner; Cottrell, Erika; Hessler, Danielle; Sheppler, Christina; Berkowitz, Seth A.

doi:10.1016/j.amepre.2022.03.011

Cited by 7 publications

(6 citation statements)

References 24 publications

(12 reference statements)

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“…Berkowitz et al and Brady et al described a higher prevalence of diabetes and hypertension among people with unmet social needs ( 48 , 49 ). Moreover, Chambers et al and Gold et al found that, among patients with diabetes, social needs were associated with poorer control of diabetes based on higher hemoglobin A1c levels ( 50 , 52 ).…”

Section: Resultsmentioning

confidence: 99%

Screening for social determinants of health among populations at risk for MASLD: a scoping review

Kim,

Ballantyne,

Conroy

et al. 2024

Front. Public Health

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BackgroundSocial determinants of health (SDoH) have been associated with disparate outcomes among those with metabolic dysfunction-associated steatotic liver disease (MASLD) and its risk factors. To address SDoH among this population, real-time SDoH screening in clinical settings is required, yet optimal screening methods are unclear. We performed a scoping review to describe the current literature on SDoH screening conducted in the clinical setting among individuals with MASLD and MASLD risk factors.MethodsThrough a systematic literature search of MEDLINE, Embase, and CINAHL Complete databases through 7/2023, we identified studies with clinic-based SDoH screening among individuals with or at risk for MASLD that reported pertinent clinical outcomes including change in MASLD risk factors like diabetes and hypertension.ResultsTen studies (8 manuscripts, 2 abstracts) met inclusion criteria involving 148,151 patients: 89,408 with diabetes and 25,539 with hypertension. Screening was primarily completed in primary care clinics, and a variety of screening tools were used. The most commonly collected SDoH were financial stability, healthcare access, food insecurity and transportation. Associations between clinical outcomes and SDoH varied; overall, higher SDoH burden was associated with poorer outcomes including elevated blood pressure and hemoglobin A1c.ConclusionDespite numerous epidemiologic studies showing associations between clinical outcomes and SDoH, and guidelines recommending SDoH screening, few studies describe in-clinic SDoH screening among individuals with MASLD risk factors and none among patients with MASLD. Future research should prioritize real-time, comprehensive assessments of SDoH, particularly among patients at risk for and with MASLD, to mitigate disease progression and reduce MASLD health disparities.

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Section: Resultsmentioning

confidence: 99%

Screening for social determinants of health among populations at risk for MASLD: a scoping review

Kim,

Ballantyne,

Conroy

et al. 2024

Front. Public Health

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“…28 CHCs play a critical role in reducing, but not completely eliminating, the adverse effect of social risks among their patients. 7 Additional resources for these clinics, such as the ability to provide blood glucose monitoring devices or mailed/delivered medications, could substantially benefit socioeconomically marginalized patients with diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…6 These patients face barriers to accessing diabetes care—many lack adequate insurance coverage and at-home health monitoring devices and face food insecurity, increasing their risk for diabetes complications. 7 The Patient Protection and Affordable Care Act (ACA) substantially increased access to health insurance through state-based Medicaid eligibility expansions and individual health insurance marketplaces. 8 Many studies have demonstrated associations between the ACA and improvements in diabetes diagnosis, access to ambulatory care, preventive services, medications, behavioral and mental health care, and chronic disease management; improved diabetes control; and reduction in diabetes expenditures.…”

Section: Introductionmentioning

confidence: 99%

The Impact of the Affordable Care Act Medicaid Expansion on Acute Diabetes Complications Among Community Health Center Patients

Huguet

Dinh

Hwang

et al. 2023

J Prim Care Community Health

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Objective: This study evaluates whether patients residing in expansion states have a greater increase in outpatient diagnoses of acute diabetes complications than those living in non-expansion states following the implementation of the Affordable Care Act (ACA). Methods: This retrospective cohort study uses electronic health records (EHR) from 10,665 non-pregnant patients, aged 19 to 64 years old who were diagnosed with diabetes in 2012 or 2013 from 347 community health centers (CHCs) across 16 states (11 expansion and 5 non-expansion states). Patients included had ≥1 outpatient ambulatory visit in each of these periods: pre-ACA: 2012 to 2013, post-ACA: 2014 to 2016, and post-ACA: 2017 to 2019. Acute diabetes-related complications were identified using International Classification Diseases (ICD-9-CM and ICD-10-CM) codes classification and could occur on or after diagnosis of diabetes. We performed difference-in-differences (DID) analysis using a generalized estimating equation to compare the change in rates of acute diabetes complications by year and by Medicaid expansion status. Results: There was a greater increase after year 2015 in visits related to abnormal blood glucose among patient living in Medicaid expansion states than in non-expansion states (2017 DID = 0.041, 95% CI = 0.027-0.056). Although both visits due to any acute diabetes complications and infection-related diabetes complications were higher among patients living in Medicaid expansion states, there was no difference in the trend overtime between expansion and non-expansion states. Conclusion: We found a significantly greater rate of visits for abnormal blood glucose in patients receiving care in expansion states relative to patients in CHCs in non-expansion states starting in 2015. Additional resources for these clinics, such as the ability to provide blood glucose monitoring devices or mailed/delivered medications, could substantially benefit patients with diabetes.

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“…Due to the substantial consequences of T2D for the health care system, identifying ways to improve the health of patients with T2D is a high priority. Given the associations between social adversity and T2D, efforts to improve diabetes-related outcomes are increasingly focused on SDOHs . Much of the existing work at the intersection of health care and SDOHs relies on area-level SDOH measures because patient-level data are not consistently available.…”

Section: Introductionmentioning

confidence: 99%

“…Given the associations between social adversity and T2D, efforts to improve diabetes-related outcomes are increasingly focused on SDOHs. 6 , 9 , 10 Much of the existing work at the intersection of health care and SDOHs relies on area-level SDOH measures because patient-level data are not consistently available. However, it is not clear that area-level measures are adequate; in a national community health center sample, Cottrell et al 11 found that area-level SDOH measures would miscategorize 52% of patients who self-reported social risk factors.…”

Section: Introductionmentioning

confidence: 99%

Association of Health-Related Social Needs With Quality and Utilization Outcomes in a Medicare Advantage Population With Diabetes

et al. 2023

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ImportanceRecent research highlights the association of social determinants of health with health outcomes of patients with type 2 diabetes (T2D).ObjectiveTo 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 ParticipantsThis 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.ExposuresEnrollment in Medicare Advantage, diagnosis of T2D, and completion of a survey on HRSNs.Main Outcomes and MeasuresQuality 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.ResultsOf 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 RelevanceIn 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.

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Cross-Sectional Associations: Social Risks and Diabetes Care Quality, Outcomes

Cited by 7 publications

References 24 publications

Screening for social determinants of health among populations at risk for MASLD: a scoping review

Screening for social determinants of health among populations at risk for MASLD: a scoping review

The Impact of the Affordable Care Act Medicaid Expansion on Acute Diabetes Complications Among Community Health Center Patients

Association of Health-Related Social Needs With Quality and Utilization Outcomes in a Medicare Advantage Population With Diabetes

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