Description
- Abstract:
- Background: Diabetes is the eighth leading cause of death in the United States, with a 20.5% prevalence in veteran populations compared to an 11.6% prevalence in non-veteran populations.1,2 Diabetes is associated with an extensive list of comorbidities and risk factors, including heart disease, obesity, and hypertension.2 The US military veteran population experiences elevated diabetes mortality and should be the focus of public health research and interventions.3 Objectives: This project examines whether there are differing levels in care uptake between veterans and non-veterans with diabetes to explain the difference in diabetes mortality between US military veteran and non-veteran populations. This will inform future interventions to improve health outcomes. Methods: Data from the 2021 Behavioral Risk Factor Surveillance System report was utilized for this analysis. Diabetes care uptake, where categories were defined as less than two visits or greater than/equal to two visits, was compared between the exposure group, veterans, and the non-exposure group, non-veterans. This information was self-reported and follows the CDC’s diabetes care uptake recommendations.4 Statistical analyses, particularly multivariate logistic regressions, were performed in STATA version 17.0, and weighting assured a nationally representative sample.5 The model included age, sex, ethnicity, income, BMI, education level, and urban/rural status. Respondents without diabetes were excluded, as were those with gestational diabetes, borderline diabetes, and those with missing or invalid information for variables of interest. The resulting analytic sample is 21,364 individuals. Results: 72% of veterans and 73% of non-veterans visit their health care provider for their diabetes the recommended amount or more. The odds ratio is 1.04 in both adjusted and unadjusted models; veterans have 1.04x the odds of visiting a health care provider the recommended number of times for their diabetes compared to non-veterans. After adjusting, the only statistically significant relationships between covariates and the outcome existed for those between the ages of 18-39, American Indians/Alaska Natives, and Hispanic Americans. The odds ratios were 0.67 (0.49, 0.90), 0.62 (0.45, 0.86), and 0.76 (0.60, 0.97), respectively, indicating that these populations have lower odds of adequate diabetes care utilization. Discussion and Limitations: The equivalent levels of diabetes care uptake between veteran and non-veteran populations suggests other reasons for the disparity in diabetes mortality. Past studies established this mortality disparity, and the results of this study imply that future research should assess disparities in the quality of care, rather than the quantity, between these populations.3 One limitation of this study is the potential recall bias when noting the number of diabetes care appointments attended. Misreporting just one visit could skew the data. Another limitation is that the operationalized definition for adequate care uptake does not account for individuals who may need less than two HCP visits to manage their diabetes.
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Citation
Kahn, Joseph,
"The Association Between Veteran Status and Adequate Diabetes Care Uptake"
(2024).
Biostatistics and Applied Data Analysis.
Brown Digital Repository. Brown University Library.
https://doi.org/10.26300/dc82-2361
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Biostatistics and Applied Data Analysis
This collection highlights student research from Brown's School of Public Health courses in Biostatistics and Applied Data Analysis. Databases used include:...- Behavioral Risk Factor Surveillance System
- National Survey of Children's Health
- National Health and Nutrition Examination Survey
- National Health and …