Ganguly Anisha P, Harms Michael, Bhavan Kavita P, Bowen Michael E
Division of General Medicine and Clinical Epidemiology, Department of Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Center of Innovation and Value, Parkland Health, Dallas, Texas.
Am J Prev Med. 2025 Sep;69(3):107949. doi: 10.1016/j.amepre.2025.107949. Epub 2025 Jun 14.
Undiagnosed diabetes is associated with lack of insurance, which decreases access to preventive care. During the COVID-19 pandemic, uninsured patients previously unknown to health systems were hospitalized.
This is a cross-sectional analysis of electronic health record data from patients with diabetes hospitalized with COVID-19 in a safety-net health system from June 2020 to December 2021, examining the association between payor status and incident diagnosis of diabetes. Incident diagnosis of diabetes was defined by excluding a prior known diagnosis of diabetes based on diagnosis codes, medications, and HgbA1c from the past 5 years. Regression analysis evaluated the association between payor status and incident diagnosis of diabetes. Data were analyzed in 2023.
Among 872 patients with diabetes hospitalized with COVID-19, 24.0% were uninsured, 34.6% received county-funded charity coverage, 17.1% received Medicaid, and 24.3% received Medicare. The rate of incident diagnosis of diabetes in the total sample was 20.3%; incident diagnosis of diabetes was more common among the uninsured (30.1%) than among county-funded charity coverage (18.2%) and Medicare (11.3%) patients. After adjusting for age, gender, race/ethnicity, and BMI, uninsured patients had higher odds of incident diagnosis of diabetes (AOR=2.64; 95% CI=1.41, 4.92; p=0.002) than Medicare patients. Odds of incident diagnosis of diabetes were similar for county-funded charity coverage and Medicare patients.
Uninsured patients had higher odds of incident diagnosis of diabetes during COVID-19 hospitalization that may have gone undetected without hospitalization. These findings reflect decreased access to preventive care and missed opportunities to screen for diabetes among the uninsured.
未确诊的糖尿病与缺乏保险相关，这会减少获得预防性护理的机会。在新冠疫情期间，医疗系统此前未知的未参保患者被收治入院。
这是一项对2020年6月至2021年12月在一个安全网医疗系统中因新冠病毒感染住院的糖尿病患者电子健康记录数据的横断面分析，研究付款人状态与糖尿病确诊之间的关联。糖尿病确诊定义为根据诊断代码、用药情况以及过去5年的糖化血红蛋白排除既往已知的糖尿病诊断。回归分析评估付款人状态与糖尿病确诊之间的关联。数据于2023年进行分析。
在872例因新冠病毒感染住院的糖尿病患者中，24.0%未参保，34.6%获得县资助的慈善保险，17.1%获得医疗补助，24.3%获得医疗保险。总样本中糖尿病确诊率为20.3%；未参保患者中的糖尿病确诊比获得县资助慈善保险（18.2%）和医疗保险（11.3%）的患者更为常见。在调整年龄、性别、种族/族裔和体重指数后，未参保患者糖尿病确诊几率高于医疗保险患者（比值比=2.64；95%置信区间=1.41，4.92；p=0.002）。县资助慈善保险患者和医疗保险患者的糖尿病确诊几率相似。
未参保患者在新冠病毒感染住院期间糖尿病确诊几率较高，若未住院可能未被发现。这些发现反映出未参保者获得预防性护理的机会减少，以及筛查糖尿病的机会缺失。
