Bennett Kevin J, McDermott Suzanne, Mann Joshua R, Hardin James
University of South Carolina, School of Medicine, Department of Family & Preventive Medicine, Columbia SC, USA.
University of South Carolina, Arnold School of Public Health, Department of Epidemiology & Biostatistics, Columbia SC, USA.
Disabil Health J. 2017 Jan;10(1):58-64. doi: 10.1016/j.dhjo.2016.09.001. Epub 2016 Sep 13.
Receiving recommended services for patients with diabetes is associated with improved outcomes and reduced morbidity. People with diabetes who also have a condition associated with disability represent one group that is at risk for health disparities.
To examine service utilization among persons with selected disabling conditions and diabetes, compared to those without.
2007-2012 Medical Expenditure Panel Survey Full-Year Consolidated files, medical conditions files, and the 1996-2012 pooled linkage files were merged for this analysis. This analysis focused on five selected conditions that are associated with disability: Visual impairment and blindness, spinal cord injury, intellectual disability, multiple sclerosis, and muscular dystrophy. Unadjusted and adjusted rates of receipt estimated using various multivariable regression techniques.
The proportion with diabetes was higher among those with a selected condition (12.1%) than without (7.1%). Respondents with a selected condition were more likely to have a foot exam; for all other services, the rate of receipt across the two groups was similar. Controlling for other factors, having a selected condition was only a significant factor for foot exams (AOR 1.49, 1.07-2.07). Different factors, but not having a selected condition, were associated with the receipt of each additional service.
In general, individuals received the full complement of recommended diabetes management services at a low rate, whether or not they had one of the selected disabling conditions. The comparison results indicated few disparities in diabetes management services among those with selected conditions compared those without these conditions, excepting foot exams, which were more common in the group with a disabling condition.
为糖尿病患者提供推荐服务与改善预后及降低发病率相关。患有糖尿病且伴有残疾相关疾病的人群是面临健康差距风险的一个群体。
与未患残疾相关疾病的糖尿病患者相比，研究患有特定残疾相关疾病的糖尿病患者的服务利用情况。
合并2007 - 2012年医疗支出面板调查全年合并文件、医疗状况文件以及1996 - 2012年汇总链接文件进行此项分析。该分析聚焦于与残疾相关的五种特定疾病：视力障碍与失明、脊髓损伤、智力残疾、多发性硬化症和肌肉萎缩症。使用各种多变量回归技术估计未调整和调整后的接受率。
患有特定疾病的人群中糖尿病患者的比例（12.1%）高于未患特定疾病的人群（7.1%）。患有特定疾病的受访者更有可能接受足部检查；对于所有其他服务，两组的接受率相似。在控制其他因素后，患有特定疾病仅对足部检查是一个显著因素（调整后比值比1.49，1.07 - 2.07）。不同因素（而非患有特定疾病）与每项额外服务的接受情况相关。
总体而言，无论是否患有选定的致残疾病，个体接受推荐的糖尿病管理服务的完整组合的比例都很低。比较结果表明，除了足部检查在患有致残疾病的人群中更常见外，患有选定疾病的人群与未患这些疾病的人群在糖尿病管理服务方面几乎没有差异。
