Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States.
Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States.
J Natl Med Assoc. 2023 Apr;115(2):244-253. doi: 10.1016/j.jnma.2023.01.015. Epub 2023 Feb 16.
Black Americans have a higher prevalence of diabetes compared to White Americans and have higher rates of complications and death. Exposure to the criminal legal system (CLS) is a social risk factor for chronic disease morbidity and mortality with significant overlap with populations most likely to experience poor diabetes outcomes. However, little is known about the association between CLS exposure and healthcare utilization patterns among U.S. adults with diabetes.
Using data from the National Survey of Drug Use and Health (2015-2018) a cross-sectional, nationally representative sample of U.S. adults with diabetes was created. Negative binomial regression was used to test the association between lifetime CLS exposure and three utilization types (emergency department (ED), inpatient, and outpatient) controlling for relevant socio-demographic and clinical covariates.
Of 11,562 (weighted to represent 25,742,034 individuals) adults with diabetes, 17.1% reported lifetime CLS exposure. In unadjusted analyses, exposure was associated with increased ED (IRR 1.30 95% CI 1.17-1.46) and inpatient utilization (IRR 1.23, 95% CI 1.01-1.50), but not outpatient visits (IRR 0.99 95% CI 0.94-1.04). The association between CLS exposure and ED (IRR 1.02, p=0.70) and inpatient utilization (IRR 1.18, p=0.12) was attenuated in adjusted analyses. Low socioeconomic status, comorbid substance use disorder, and comorbid mental illness were independently associated with health care utilization in this population.
Among those with diabetes, lifetime CLS exposure is associated with higher ED and inpatient visits in unadjusted analyses. Adjusting for socioeconomic status and clinical confounders attenuated these relationships, thus more research is needed to understand how CLS exposure interacts with poverty, structural racism, addiction and mental illness to influence health care utilization for adults with diabetes.
与美国白人相比，非裔美国人患糖尿病的比例更高，且并发症和死亡率更高。接触刑事司法系统（CLS）是导致慢性病发病率和死亡率的社会风险因素，与最有可能出现不良糖尿病结局的人群存在显著重叠。然而，对于 CLS 暴露与美国成年糖尿病患者医疗保健利用模式之间的关联，我们知之甚少。
使用全国毒品使用和健康调查（2015-2018 年）的数据，创建了一个横截面、全国代表性的美国成年糖尿病患者样本。使用负二项回归检验终生 CLS 暴露与三种利用类型（急诊部（ED）、住院和门诊）之间的关联，同时控制相关社会人口统计学和临床协变量。
在 11562 名（加权以代表 25742034 人）患有糖尿病的成年人中，17.1%报告有终生 CLS 暴露。在未调整的分析中，暴露与 ED（IRR 1.30，95%CI 1.17-1.46）和住院利用（IRR 1.23，95%CI 1.01-1.50）增加相关，但与门诊就诊无关（IRR 0.99，95%CI 0.94-1.04）。在调整分析中，CLS 暴露与 ED（IRR 1.02，p=0.70）和住院利用（IRR 1.18，p=0.12）之间的关联减弱。在该人群中，低社会经济地位、合并物质使用障碍和合并精神疾病与医疗保健利用独立相关。
在患有糖尿病的人群中，终生 CLS 暴露与未经调整分析中的 ED 和住院就诊次数增加相关。调整社会经济地位和临床混杂因素减弱了这些关系，因此需要进一步研究以了解 CLS 暴露如何与贫困、结构性种族主义、成瘾和精神疾病相互作用，从而影响成年糖尿病患者的医疗保健利用。
