Background
Methods
Dataset and Sample
Outcome Measures
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Physician visit. Having one or more physician visits in the past 12 months was coded dichotomously (yes/no). 7,254 individuals were available for analysis.
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HbA1c test. This was assessed by asking “How many times in the past 12 months has a doctor, nurse, or other health professional checked you for ‘A one C’?” The response options were discrete integers. A dichotomous variable categorized as at least one vs. none was computed. 7,071 individuals were available for analysis.
-
Dilated eye exam by provider. Values were derived from the question “When was the last time you had eye exam in which the pupils were dilated? This would have made you temporarily sensitive to bright light?” Individuals reporting at least one dilated eye exam in the past 12 months were considered to meet quality of care recommendations (3) and were coded as “yes” to create a dichotomous variable. 7,344 individuals were available for analysis.
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Diabetes Education. Receipt of education was assessed by asking respondents “Have you ever taken a course or class in how to manage your diabetes yourself?”. A dichotomous variable was created (yes/no). 7,398 individuals were available for analysis.
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Flu shot. Receipt of the flu shot was assessed by asking respondents whether they got the flu shot in the past 12 months. A dichotomous variable was created (yes/no). 12,755 individuals were available for analysis.
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Home blood glucose monitoring. Respondents were asked “about how often do you check your blood for glucose or sugar? Include times when checked by a family member or friend, but do not include times when checked by a health professional.” A dichotomous variable for frequency of monitoring was created—check sometimes vs. never checks (Yes vs. No). 6,428 individuals were available for analysis.
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Home foot examination. Foot care behavior was assessed by asking respondents “about how often do you check your feet for any sores or irritations? Include times when checked by a family member or friend, but do not include times when checked by a health professional.” A dichotomous variable for frequency of foot examination was created—check sometimes vs. never checks (Yes vs. No). 6,280 individuals were available for analysis.
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Physical activity. Participants were asked “during the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?” An individual was deemed to be physically active if they answered “Yes” to this question. 12,748 individuals were available for analysis.
Primary independent variable
Covariates
Statistical Analysis
Results
Mean (S.E) or % | Weighted sample size | |
---|---|---|
Housing Insecurity
| 38.1% (0.01) | |
Age (in years) | 60.5 (0.19) | |
Gender
| ||
Male | 48.9% | 3,543,958 |
Female | 51.1% | 3,703,975 |
Race
| ||
Non-Hispanic White | 69.5% | 4,971,163 |
Non-Hispanic Black | 23.4% | 1,674,704 |
Hispanic/Other | 7.1% | 506,734 |
Education
| ||
Less than High School | 19.7% | 1,425,217 |
High School Graduate/GED | 32.3% | 2,337,627 |
Some College | 31.4% | 2,270,780 |
College Graduate | 16.6% | 1,201,093 |
Marital Status
| ||
Married | 55.4% | 4,005,902 |
Unmarried | 44.6% | 3,226,559 |
Household total income category
| ||
Less than $25,000 | 40.0% | 2,484,423 |
$25,000-$75,000 | 42.1% | 2,617,040 |
More than $75,000 | 17.8% | 1,107,219 |
Employment Status
| ||
Employed | 67.2% | 4,860,787 |
Unemployed | 32.8% | 2,369,576 |
Health Insurance Status
| ||
Insured | 92.6% | 6,693,971 |
Uninsured | 7.4% | 538,472 |
Comorbidity Count
| 1.5 (0.02) |
Outcome Variables | OR (95% Cl) | p-value |
---|---|---|
Diabetes Processes of Care
| ||
Doctor Visit |
0.67 (0.53-0.85)
|
0.001
|
A1c Check | 0.49 (0.38-0.63) |
0.000
|
Eye Exam |
0.60 (0.52-0.70)
|
0.000
|
Diabetes Education | 0.83 (0.72-0.95) |
0.01
|
Flu vaccine |
0.70 (0.62-0.78)
|
0.000
|
Diabetes Self-Care Behaviors
| ||
Blood Sugar Test | 1.25 (1.05-1.48) |
0.01
|
Foot Check |
1.35 (1.13-1.60)
|
0.001
|
Physical Activity |
1.25 (1.05-1.48)
|
0.01
|
Unemployed | Employed | |||
---|---|---|---|---|
aOR (95% Cl)
|
p
-value
|
aOR (95% Cl)
|
p
-value
| |
Diabetes Processes of Care
| ||||
Doctor Visit | 0.84 (0.58-1.24) | 0.391 |
0.58 (0.37-0.92)
|
0.010
|
A1c Check | 1.07 (0.72-1.61) | 0.710 |
0.45 (0.26-0.78)
|
0.005
|
Eye Exam | 0.88 (0.69-1.11) | 0.308 |
0.61 (0.44-0.83)
|
0.002
|
Diabetes Education | 0.96 (0.77-1.19) | 0.707 | 0.92 (0.67-1.26) | 0.588 |
Flu vaccine |
0.84 (0.70-0.99)
|
0.043
| 0.88 (0.68-1.13) | 0.326 |
Diabetes Self-Care Behaviors
| ||||
Blood Sugar Test | 1.04 (0.79-1.36) | 0.801 | 1.03 (0.74-1.44) | 0.857 |
Foot Check | 1.14 (0.89-1.46) | 0.291 |
1.51 (1.04-2.19)
|
0.029
|
Physical Activity | 0.90 (0.76-1.08) | 0.254 | 0.81 (0.63-1.06) | 0.130 |
Non-Hispanic White | Non-Hispanic Black | Hispanic/Other | ||||
---|---|---|---|---|---|---|
aOR (95% Cl)
|
p
-value
|
aOR (95% Cl)
|
p
-value
|
aOR (95% Cl)
|
p
-value
| |
Diabetes Processes of Care
| ||||||
Doctor Visit | 0.83 (0.59-1.15) | 0.263 |
0.56 (0.32-0.99)
| 0.049 | 0.49 (0.16-1.49) | 0.212 |
A1c Check | 0.91 (0.62-1.34) | 0.626 | 0.67 (0.37-1.21) | 0.184 | 0.35 (0.09-1.36) | 0.130 |
Eye Exam |
0.67 (0.54-0.83)
|
<0.001
| 0.84 (0.57-1.24) | 0.384 | 1.68 (0.88-3.21) | 0.113 |
Diabetes Education | 0.90 (0.74-1.11) | 0.321 | 0.94 (0.65-1.34) | 0.715 | 0.95 (0.47-1.89) | 0.879 |
Flu vaccine |
0.84 (0.71-0.99)
|
0.038
| 0.84 (0.63-1.12) | 0.241 | 1.25 (0.73-2.16) | 0.416 |
Diabetes Self-Care Behaviors
| ||||||
Blood Sugar Test | 0.98 (0.78-1.25) | 0.923 | 1.07 (0.70-1.63) | 0.750 | 1.17 (0.51-2.65) | 0.709 |
Foot Check | 1.23 (0.96-1.57) | 0.101 | 1.40 (0.89-2.21) | 0.143 | 1.19 (0.58-2.46) | 0.626 |
Physical Activity |
0.82 (0.69-0.96)
|
0.016
| 1.06 (0.76-1.46) | 0.741 | 0.76 (0.45-1.31) | 0.323 |