College of Nursing and Disability, Aging and Technology Cluster, University of Central Florida, Orlando, Florida, United States of America.
Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2020 Nov 10;15(11):e0241757. doi: 10.1371/journal.pone.0241757. eCollection 2020.
Diabetes imposes large health and financial burdens on Medicare beneficiaries. Type 2 diabetes can be prevented or delayed through lifestyle modification programs. In 2018, Medicare began to offer the Medicare Diabetes Prevention Program (MDPP), a lifestyle intervention, to eligible beneficiaries nationwide. The number of MDPP-eligible beneficiaries is not known, but this information is essential in efforts to expand the program and increase enrollment. This study aimed to estimate the number and spatial variation of MDPP-eligible Part B beneficiaries at the county level and by urban-rural classification.
Data from 2011-2016 National Health and Nutrition Examination Surveys and a survey-weighted logistic regression model were used to estimate proportions of prediabetes in the United States by sex, age, and race/ethnicity based on the MDPP eligibility criteria. The results from the predictive model were applied to 2015 Medicare Part B beneficiaries to estimate the number of MDPP-eligible beneficiaries. The National Center for Health Statistics' Urban-Rural Classification Scheme for Counties from 2013 were used to define urban and rural categories.
An estimated 5.2 million (95% CI = 3.5-7.0 million) Part B beneficiaries were eligible for the MDPP. By state, estimates ranged from 13,000 (95% CI = 8,500-18,000) in Alaska to 469,000 (95% CI = 296,000-641,000) in California. There were 2,149 counties with ≤1,000 eligible beneficiaries and 11 with >25,000. Consistent with demographic patterns, urban counties had more eligible beneficiaries than rural counties.
These estimates could be used to plan locations for new MDPPs and reach eligible Part B beneficiaries for enrollment.
糖尿病给医疗保险受益人大幅增加了健康和经济负担。通过生活方式改变计划可以预防或延迟 2 型糖尿病的发生。2018 年，医疗保险开始向全国符合条件的受益人提供医疗保险糖尿病预防计划（MDPP），这是一种生活方式干预措施。MDPP 合格受益人的数量尚不清楚，但这一信息对于扩大该计划并增加参与人数至关重要。本研究旨在估计县级和城乡分类的 MDPP 合格 B 部分受益人的数量和空间变化。
使用 2011-2016 年全国健康和营养调查数据以及经过调查加权的逻辑回归模型，根据 MDPP 的合格标准，按性别、年龄和种族/族裔在美国估算糖尿病前期的比例。将预测模型的结果应用于 2015 年医疗保险 B 部分受益人的数据，以估算 MDPP 合格受益人的数量。使用 2013 年国家卫生统计中心的县城乡分类方案来定义城乡类别。
估计有 520 万（95%置信区间=350 万至 700 万）B 部分受益人有资格参加 MDPP。按州划分，估计值从阿拉斯加的 13,000（95%置信区间=8,500-18,000）到加利福尼亚的 469,000（95%置信区间=296,000-641,000）不等。有 2149 个县的合格受益人少于 1000 人，有 11 个县的合格受益人超过 25000 人。与人口统计模式一致，城市县的合格受益人比农村县多。
这些估计数可用于规划新 MDPP 的地点，并为合格的 B 部分受益人提供入组机会。
