Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA.
School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA.
Int J Environ Res Public Health. 2020 Jun 30;17(13):4706. doi: 10.3390/ijerph17134706.
Over a third of adults in the United States have prediabetes, and many of those with prediabetes will progress to type 2 diabetes within 3-5 years. Health insurance status may factor into a proper diagnosis of prediabetes and diabetes. This study sought to determine the associations between health insurance and undiagnosed prediabetes and diabetes in a national sample of American adults. Publicly available data from 13,029 adults aged 18-64 years from the 2005-2016 waves of the National Health and Nutrition Examination Survey were analyzed. Health insurance type (Medicaid, Private, Other, None) was self-reported. Prediabetes and diabetes status were assessed with measures of self-report, glycohemoglobin, fasting plasma glucose, and two-hour glucose. Covariate-adjusted logistic models were used for the analyses. Overall, 5976 (45.8%) participants had undiagnosed prediabetes, while 897 (6.8%) had undiagnosed diabetes. Having health insurance was associated with decreased odds ratios for undiagnosed prediabetes: 0.87 (95% confidence interval (CI: 0.79, 0.95)) for private insurance, 0.84 (CI: 0.73, 0.95) for other insurance, and 0.78 (CI: 0.67, 0.90) for Medicaid. Moreover, having private health insurance was associated with 0.82 (CI: 0.67, 0.99) decreased odds for undiagnosed diabetes. Health insurance coverage and screening opportunities for uninsured individuals may reduce prediabetes and diabetes misclassifications.
超过三分之一的美国成年人患有前驱糖尿病，其中许多前驱糖尿病患者将在 3-5 年内发展为 2 型糖尿病。健康保险状况可能会影响前驱糖尿病和糖尿病的正确诊断。本研究旨在确定健康保险与美国成年人群体中未确诊的前驱糖尿病和糖尿病之间的关联。分析了来自 2005-2016 年全国健康和营养检查调查的 13029 名 18-64 岁成年人的公开可用数据。健康保险类型（医疗补助、私人、其他、无）由自我报告。使用自我报告、糖化血红蛋白、空腹血浆葡萄糖和两小时葡萄糖来评估前驱糖尿病和糖尿病状况。分析采用了协变量调整的逻辑模型。总体而言，5976 名（45.8%）参与者患有未确诊的前驱糖尿病，而 897 名（6.8%）患有未确诊的糖尿病。拥有健康保险与未确诊的前驱糖尿病的几率降低相关：私人保险的比值比为 0.87（95%置信区间：0.79，0.95），其他保险为 0.84（0.73，0.95），医疗补助为 0.78（0.67，0.90）。此外，拥有私人健康保险与未确诊糖尿病的几率降低 0.82（95%置信区间：0.67，0.99）相关。健康保险的覆盖范围和未参保人群的筛查机会可能会减少前驱糖尿病和糖尿病的误诊。
