Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States.
Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States.
Prim Care Diabetes. 2023 Dec;17(6):612-618. doi: 10.1016/j.pcd.2023.10.002. Epub 2023 Oct 17.
We evaluated patient-level factors associated with receipt of hemoglobin A1c (HbA1c) testing among Alabama Medicaid beneficiaries with type 2 diabetes.
We conducted a retrospective analysis of person-year observations from Medicaid claims data from 2011 to 2020. Adults aged 19-64 years with type 2 diabetes and continuous enrollment in Medicaid for study year and year prior were included. Primary outcomes were ≥ 1 and ≥ 2 HbA1c test(s) per year. We conducted multivariable Poisson regression stratified by Medicaid eligibility reason (disability, poverty) examining the association of study year, demographics, clinical factors, and healthcare utilization with HbA1c testing.
We analyzed 288,379 observations, 51% with disability-based, 49% poverty-based eligibility. Overall, 57% observations had ≥ 1 HbA1c, 35% had ≥ 2 HbA1c tests. More observations with disability-based than poverty-based eligibility had ≥ 1 (76% vs. 38%) and ≥ 2 HbA1c tests (49% vs. 20%). Patient-level factors were associated with a higher likelihood of having ≥ 1 HbA1c: Black race and older age (disability-based eligibility); year after 2011, female sex, and younger age (poverty-based eligibility); and rurality, insulin use, endocrinology care, diabetes complications, and ambulatory care visits (both groups).
Just over one-third of adult Alabama Medicaid beneficiaries with diabetes had ≥ 2 HbA1c tests per year; testing frequency differed by Medicaid eligibility.
我们评估了与阿拉巴马州医疗补助计划（Medicaid）受益的 2 型糖尿病患者接受血红蛋白 A1c（HbA1c）检测相关的患者水平因素。
我们对 2011 年至 2020 年 Medicaid 索赔数据中的人员-年观察值进行了回顾性分析。纳入年龄在 19-64 岁之间、患有 2 型糖尿病且在研究年和前一年连续参加 Medicaid 的成年人。主要结局是每年≥1 次和≥2 次 HbA1c 检测。我们对 Medicaid 资格原因（残疾、贫困）进行了多变量泊松回归分层分析，研究了研究年份、人口统计学因素、临床因素和医疗保健利用与 HbA1c 检测的相关性。
我们分析了 288379 个观察值，其中 51%基于残疾，49%基于贫困。总体而言，57%的观察值有≥1 次 HbA1c 检测，35%有≥2 次 HbA1c 检测。基于残疾的资格比基于贫困的资格有更多的观察值有≥1（76%比 38%）和≥2 次 HbA1c 检测（49%比 20%）。患者水平因素与有更高可能性进行≥1 次 HbA1c 检测相关：黑人种族和年龄较大（基于残疾的资格）；2011 年后的年份、女性和年龄较小（基于贫困的资格）；以及农村地区、胰岛素使用、内分泌科护理、糖尿病并发症和门诊护理就诊（两组）。
超过三分之一的阿拉巴马州 Medicaid 受益的成年 2 型糖尿病患者每年有≥2 次 HbA1c 检测；检测频率因 Medicaid 资格而异。
