Sohn Min-Woong, Kang Hyojung, Park Joseph S, Yates Paul, McCall Anthony, Stukenborg George, Anderson Roger, Balkrishnan Rajesh, Lobo Jennifer M
Department of Public Health Sciences , School of Medicine, University of Virginia , Charlottesville, Virginia , USA.
Department of Systems and Information Engineering , School of Engineering, University of Virginia , Charlottesville, Virginia , USA.
BMJ Open Diabetes Res Care. 2016 Dec 23;4(1):e000284. doi: 10.1136/bmjdrc-2016-000284. eCollection 2016.
To examine disparities in the receipt of preventive care recommended by the American Diabetes Association (ADA) between Appalachian and non-Appalachian counties and within Appalachian counties.
Behavioral Risk Factor Surveillance System (BRFSS) data for 2008-2010 were used to identify individuals with diabetes and their preventive care usage. Each Appalachian respondent county of residence was categorised into one of the five economic levels: distressed, at-risk, transitional, competitive and attainment counties. Competitive and attainment counties were combined and designated as competitive counties. We used logistic regressions to compare receipt of ADA preventive care recommendations by county economic level, adjusting for respondent demographic, socioeconomic, health and access-to-care factors.
Compared to the most affluent (competitive) counties, less affluent (distressed and at-risk) counties demonstrated equivalent or higher rates of self-care practices such as daily blood glucose monitoring and daily foot checks. But they showed 40-50% lower uptake of annual foot and eye examinations and 30% lower uptake of diabetes education and pneumococcal vaccinations compared to competitive counties. After adjusting for demographic factors, significant disparities still existed in the uptake of annual foot examinations, annual eye examinations, 2 or more A1c tests per year and pneumococcal vaccinations in distressed and at-risk counties compared to competitive counties. Appalachian counties as a whole were similar to non-Appalachian counties in the uptake of all recommendations with the absolute differences of ≤3%.
Our results show that there are significant disparities in the uptake of many recommended preventive services between less and more affluent counties in the Appalachian region.
研究阿巴拉契亚县和非阿巴拉契亚县之间以及阿巴拉契亚县内部在接受美国糖尿病协会（ADA）推荐的预防保健方面的差异。
使用2008 - 2010年行为危险因素监测系统（BRFSS）的数据来确定糖尿病患者及其预防保健的使用情况。每个阿巴拉契亚受访者居住县被归类为五个经济水平之一：困境县、风险县、过渡县、竞争县和达标县。竞争县和达标县合并并指定为竞争县。我们使用逻辑回归按县经济水平比较ADA预防保健建议的接受情况，并对受访者的人口统计学、社会经济、健康和就医因素进行调整。
与最富裕（竞争）的县相比，较不富裕（困境和风险）的县在自我保健措施（如每日血糖监测和每日足部检查）方面表现出相当或更高的比率。但与竞争县相比，他们每年足部和眼部检查的接受率低40 - 50%，糖尿病教育和肺炎球菌疫苗接种的接受率低30%。在调整人口统计学因素后，与竞争县相比，困境县和风险县在每年足部检查、每年眼部检查、每年2次或更多次糖化血红蛋白（A1c）检测以及肺炎球菌疫苗接种的接受方面仍存在显著差异。阿巴拉契亚县作为一个整体在所有建议的接受方面与非阿巴拉契亚县相似，绝对差异≤3%。
我们的结果表明，阿巴拉契亚地区较富裕和较不富裕的县在许多推荐的预防服务接受方面存在显著差异。
