Lindenfeld Zoe, Chen Kevin, Kapur Supriya, Chang Ji E
Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA.
Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York, NY, USA.
J Gen Intern Med. 2024 Jul;39(9):1632-1641. doi: 10.1007/s11606-024-08718-6. Epub 2024 Mar 11.
Individuals with substance use disorders (SUDs) have increased risk for developing chronic conditions, though few studies assess rates of diagnosis of these conditions among patients with SUDs.
To compare rates of undiagnosed hypertension and diabetes among patients with and without an SUD.
Cross-sectional analysis using electronic health record (EHR) data from 58 primary care clinics at a large, urban, healthcare system in New York.
Patients who had at least two primary care visits from 2019-2022 were included in our patient sample. Patients without an ICD-10 hypertension diagnosis or prescribed hypertension medications and with at least two blood pressure (BP) readings ≥ 140/90 mm were labeled 'undiagnosed hypertension,' and patients without a diabetes diagnosis or prescribed diabetes medications and with A1C/hemoglobin ≥ 6.5% were labeled 'undiagnosed diabetes.'
We calculated the mean number of patients with and without an ICD-10 SUD diagnosis who were diagnosed and undiagnosed for each condition. We used multivariate logistic regression to assess the association between being undiagnosed for each condition, and having an SUD diagnosis, patient demographic characteristics, clinical characteristics (body mass index, Elixhauser comorbidity count, diagnosed HIV and psychosis), the percentage of visits without a BP screening, and the total number of visits during the time period.
The percentage of patients with undiagnosed hypertension (2.74%) and diabetes (22.98%) was higher amongst patients with SUD than patients without SUD. In multivariate models, controlling for other factors, patients with SUD had significantly higher odds of having undiagnosed hypertension (OR: 1.81; 95% CI: 1.48, 2.20) and undiagnosed diabetes (OR: 1.93; 1.72, 2.16). Being younger, female, and having an HIV diagnosis was also associated with significantly higher odds for being undiagnosed.
We found significant disparities in rates of undiagnosed chronic diseases among patients with SUDs, compared with patients without SUDs.
患有物质使用障碍（SUDs）的个体患慢性病的风险增加，尽管很少有研究评估SUD患者中这些疾病的诊断率。
比较有和没有SUD的患者中未诊断高血压和糖尿病的发生率。
使用来自纽约一个大型城市医疗系统中58家初级保健诊所的电子健康记录（EHR）数据进行横断面分析。
2019年至2022年期间至少有两次初级保健就诊的患者被纳入我们的患者样本。没有ICD-10高血压诊断或未开具高血压药物处方且至少有两次血压（BP）读数≥140/90 mmHg的患者被标记为“未诊断高血压”，没有糖尿病诊断或未开具糖尿病药物处方且糖化血红蛋白（A1C）/血红蛋白≥6.5%的患者被标记为“未诊断糖尿病”。
我们计算了有和没有ICD-10 SUD诊断的患者中每种疾病已诊断和未诊断的患者平均人数。我们使用多变量逻辑回归来评估每种疾病未诊断与SUD诊断、患者人口统计学特征、临床特征（体重指数、埃利克斯豪泽合并症计数、已诊断的艾滋病毒和精神病）、无血压筛查的就诊百分比以及该时间段内的就诊总数之间的关联。
SUD患者中未诊断高血压（2.74%）和糖尿病（22.98%）的患者百分比高于无SUD的患者。在多变量模型中，在控制其他因素后，SUD患者未诊断高血压（比值比：1.81；95%置信区间：1.48，2.20）和未诊断糖尿病（比值比：1.93；1.72，2.16）的几率显著更高。年龄较小、女性以及患有艾滋病毒诊断也与未诊断的几率显著更高相关。
我们发现，与无SUD的患者相比，SUD患者中未诊断慢性病的发生率存在显著差异。
