Kwon KiBeom, Brown Taylor A, Arias Aristizábal Juan C, Armstrong David G, Tan Tze-Woei
Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA.
College of Medicine, University of Arizona, Tucson, AZ 85724, USA.
Diabetology (Basel). 2024 Aug;5(3):356-364. doi: 10.3390/diabetology5030027. Epub 2024 Aug 21.
This study investigates the outcomes of Medicaid beneficiaries with diabetic foot ulcers (DFUs) who had transitioned to commercial insurance.
We utilized the PearlDiver claims database to identify adult patients diagnosed with a new DFU between 2010 and 2019. The study cohort comprised 8856 Medicaid beneficiaries who had at least three years of continuous enrollment after DFU diagnosis. Medicaid beneficiaries who transitioned to Medicare during follow-up were excluded. Adjusted comparisons of outcomes were performed by propensity matching the two groups for age, gender, and Charlson Comorbidity Index (CCI) in a 1:1 ratio. We used logistic regression and Kaplan-Meier estimate to evaluate the association between insurance change (from Medicaid to commercial insurance) and major amputation.
Among the 8856 Medicaid beneficiaries with DFUs, 66% ( = 5809) had transitioned to commercial insurance coverage during follow-up. The overall major amputation rate was 2.8% ( = 247), with a lower rate observed in patients who transitioned to commercial insurance compared to those with continuous Medicaid coverage (2.6% vs. 3.2%, < 0.05). In multivariable analysis, Medicaid beneficiaries who transitioned to commercial insurance had a 27% lower risk of major amputation (study cohort: odds ratios [OR] 0.75, 95% CI 0.56-0.97, = 0.03; matched cohort: OR 0.65, 95% 0.22, 0.55, = 0.01) compared to those with continuous Medicaid coverage.
Transitioning from Medicaid to commercial insurance may be associated with a lower risk of major amputation among Medicaid beneficiaries with DFUs.
本研究调查了已转为商业保险的糖尿病足溃疡（DFU）医疗补助受益人的结局。
我们利用PearlDiver索赔数据库识别出2010年至2019年间被诊断为新发DFU的成年患者。研究队列包括8856名医疗补助受益人，他们在DFU诊断后至少连续参保三年。随访期间转为医疗保险的医疗补助受益人被排除。通过按年龄、性别和Charlson合并症指数（CCI）以1:1的比例对两组进行倾向匹配，对结局进行调整后的比较。我们使用逻辑回归和Kaplan-Meier估计来评估保险变更（从医疗补助转为商业保险）与大截肢之间的关联。
在8856名患有DFU的医疗补助受益人中，66%（n = 5809）在随访期间已转为商业保险。总体大截肢率为2.8%（n = 247），转为商业保险的患者的截肢率低于持续享有医疗补助的患者（2.6%对3.2%，P < 0.05）。在多变量分析中，与持续享有医疗补助的受益人相比，转为商业保险的医疗补助受益人发生大截肢的风险降低了27%（研究队列：比值比[OR] 0.75，95%置信区间0.56 - 0.97，P = 0.03；匹配队列：OR 0.65，95% 0.22，0.55，P = 0.01）。
从医疗补助转为商业保险可能与患有DFU的医疗补助受益人中大截肢风险较低有关。
