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支持性住房及其与纽约市无家可归者糖尿病诊断和管理的关系。

Supportive Housing and Its Relationship With Diabetes Diagnosis and Management Among Homeless Persons in New York City.

机构信息

Bureau of Epidemiology Services, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York.

Bureau of Primary Care Information Project, Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, New York, New York.

出版信息

Am J Epidemiol. 2019 Jun 1;188(6):1120-1129. doi: 10.1093/aje/kwz057.

Abstract

Supportive housing addresses a fundamental survival need among homeless persons, which can lead to reduced risk of diabetes mellitus and improved diabetes care. We tested the association between supportive housing and diabetes outcomes among homeless adults who were eligible for New York City's supportive housing program in 2007-2012. We used multiple administrative data sources, identifying 7,525 Medicaid-eligible adults. The outcomes included receiving medical evaluation and management services, hemoglobin A1C and lipid testing (n = 1,489 persons with baseline diabetes), and incidence of new diabetes diagnoses (n = 6,036 persons without baseline diabetes) in the 2 years postbaseline. Differences in these outcomes by placement were estimated using inverse-probability-of-treatment weighting. Placed persons were more likely to receive evaluation and management services (relative risk (RR) = 1.03, 95% confidence interval (CI): 1.01, 1.04) than unplaced persons. For those with baseline diabetes, placed persons were more likely to receive hemoglobin A1C tests (RR = 1.10, 95% CI: 1.02, 1.19) and lipid tests (RR = 1.09, 95% CI: 1.02, 1.17). For those without baseline diabetes, placement was also associated with lower risk of new diabetes diagnoses (RR = 0.87, 95% CI: 0.76, 0.99). These findings show that benefits of supportive housing may be extended to diabetes care and prevention.

摘要

支持性住房满足了无家可归者的基本生存需求,从而降低了患糖尿病的风险并改善了糖尿病的护理。我们检验了 2007 年至 2012 年期间符合纽约市支持性住房计划的无家可归成年人获得支持性住房与糖尿病结果之间的关联。我们使用了多个行政数据来源,确定了 7525 名有资格参加医疗补助计划的成年人。结果包括在基线后 2 年内接受医疗评估和管理服务、糖化血红蛋白和血脂测试(基线时有糖尿病的 1489 人)和新发糖尿病诊断(基线时无糖尿病的 6036 人)。使用治疗反概率加权来估计这些结果的差异。安置人员更有可能接受评估和管理服务(相对风险(RR)=1.03,95%置信区间(CI):1.01,1.04)比未安置人员。对于基线时有糖尿病的人,安置人员更有可能接受糖化血红蛋白测试(RR=1.10,95%CI:1.02,1.19)和血脂测试(RR=1.09,95%CI:1.02,1.17)。对于基线时无糖尿病的人,安置也与新发糖尿病诊断风险降低相关(RR=0.87,95%CI:0.76,0.99)。这些发现表明,支持性住房的益处可能会扩展到糖尿病的护理和预防。

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