美国健康保险状况和类型与血糖控制水平的相关性：动脉粥样硬化多民族研究（MESA）。
Health insurance status and type associated with varying levels of glycemic control in the US: The multi-ethnic study of atherosclerosis (MESA).
机构信息
School of Medicine, University of California San Diego, La Jolla, California, USA.
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA.
出版信息
Prim Care Diabetes. 2021 Apr;15(2):378-384. doi: 10.1016/j.pcd.2020.11.011. Epub 2020 Dec 9.
AIMS
To investigate associations of health insurance with measures of glucose metabolism, and whether associations vary by diabetes status or insurance type.
METHODS
Cross-sectional analysis of baseline data from the Multi-Ethnic Study of Atherosclerosis. Cohort a priori stratified by age <65 (N = 3,665) and ≥65 years (N = 2,924). Multivariable linear and logistic regression assessed associations between insurance and fasting glucose, HOMA-IR, and prevalent diabetes, controlling for relevant confounders, including age, sex, race/ethnicity, income, and education.
RESULTS
In participants <65, compared to uninsured, having any insurance was associated with lower fasting glucose in participants with diabetes (Mean Difference = -20.4 mg/dL, P = 0.01), but not in participants without diabetes. Compared to Private insurance, uninsured participants had higher fasting glucose (Mean Difference = 3.8 mg/dL, P = 0.03), while participants with Medicaid had higher HOMA-IR (Mean Difference = 3.5 mg/dL, P < 0.01). In participants ≥65, compared to Private insurance, uninsured participants (Mean Difference = 7.5 mg/dL, P = 0.02), and participants with Medicaid only (Mean Difference = 19.9 mg/dL, P < 0.01) or Medicare + Medicaid (Mean Difference = 5.2 mg/dL, P = 0.03) had higher fasting glucose.
CONCLUSIONS
In this large multiethnic cohort, having any insurance was associated with significantly lower fasting glucose for individuals with diabetes. Levels of fasting glucose and insulin resistance varied across different insurance types.
目的
调查健康保险与血糖代谢指标的关联，以及这些关联是否因糖尿病状况或保险类型而异。
方法
对动脉粥样硬化多民族研究的基线数据进行横断面分析。队列根据年龄<65（N=3665）和≥65 岁（N=2924）进行预先分层。多变量线性和逻辑回归评估了保险与空腹血糖、HOMA-IR 和糖尿病患病率之间的关联，控制了相关混杂因素，包括年龄、性别、种族/民族、收入和教育。
结果
在<65 岁的参与者中，与未参保者相比，任何保险类型均与糖尿病患者的空腹血糖降低相关（平均差异=-20.4mg/dL，P=0.01），但与非糖尿病患者无关。与私人保险相比，未参保者的空腹血糖较高（平均差异=3.8mg/dL，P=0.03），而 Medicaid 参保者的 HOMA-IR 较高（平均差异=3.5mg/dL，P<0.01）。在≥65 岁的参与者中，与私人保险相比，未参保者（平均差异=7.5mg/dL，P=0.02）和仅 Medicaid 参保者（平均差异=19.9mg/dL，P<0.01）或 Medicare+Medicaid 参保者（平均差异=5.2mg/dL，P=0.03）的空腹血糖较高。
结论
在这项大型多民族队列研究中，对于糖尿病患者，拥有任何一种保险都与空腹血糖显著降低有关。空腹血糖和胰岛素抵抗水平因不同的保险类型而异。
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