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Epidemiology/health services research
Disparities in recommended preventive care usage among persons living with diabetes in the Appalachian region
  1. Min-Woong Sohn1,
  2. Hyojung Kang2,
  3. Joseph S Park3,
  4. Paul Yates4,
  5. Anthony McCall5,
  6. George Stukenborg1,
  7. Roger Anderson1,
  8. Rajesh Balkrishnan1,
  9. Jennifer M Lobo1
  1. 1Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
  2. 2Department of Systems and Information Engineering, School of Engineering, University of Virginia, Charlottesville, Virginia, USA
  3. 3Department of Orthopaedic Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
  4. 4Department of Ophthalmology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
  5. 5Department of Medicine, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
  1. Correspondence to Dr Jennifer Mason Lobo; jem4yb{at}virginia.edu

Abstract

Objective To examine disparities in the receipt of preventive care recommended by the American Diabetes Association (ADA) between Appalachian and non-Appalachian counties and within Appalachian counties.

Research design and methods Behavioral Risk Factor Surveillance System (BRFSS) data for 2008–2010 were used to identify individuals with diabetes and their preventive care usage. Each Appalachian respondent county of residence was categorised into one of the five economic levels: distressed, at-risk, transitional, competitive and attainment counties. Competitive and attainment counties were combined and designated as competitive counties. We used logistic regressions to compare receipt of ADA preventive care recommendations by county economic level, adjusting for respondent demographic, socioeconomic, health and access-to-care factors.

Results Compared to the most affluent (competitive) counties, less affluent (distressed and at-risk) counties demonstrated equivalent or higher rates of self-care practices such as daily blood glucose monitoring and daily foot checks. But they showed 40–50% lower uptake of annual foot and eye examinations and 30% lower uptake of diabetes education and pneumococcal vaccinations compared to competitive counties. After adjusting for demographic factors, significant disparities still existed in the uptake of annual foot examinations, annual eye examinations, 2 or more A1c tests per year and pneumococcal vaccinations in distressed and at-risk counties compared to competitive counties. Appalachian counties as a whole were similar to non-Appalachian counties in the uptake of all recommendations with the absolute differences of ≤3%.

Conclusions Our results show that there are significant disparities in the uptake of many recommended preventive services between less and more affluent counties in the Appalachian region.

  • Adult Diabetes
  • Preventive Medicine
  • Foot Care
  • Eye Exam

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjdrc-2016-000284

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    Footnotes

    • Contributors M-WS derived the hypothesis, planned and supervised all analyses. M-WS and JL conducted analyses. M-WS wrote the manuscript. All authors participated in the interpretation of results and revision of the manuscript.

    • Disclaimer The paper presents the findings and conclusions of the authors; it does not necessarily represent the Agency for Healthcare Research and Quality. The corresponding author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding Agency for Healthcare Research and Quality, R01HS018542.

    • Competing interests None declared.

    • Ethics approval This study was exempt from institutional review board approval because the BRFSS data were one of the approved public-use data sets.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.