Article Figures & Data
Figures
- Figure 1.
Structure of the Community Health Applied Research Network (CHARN).22 *Overall governance of the network is the responsibility of the CHARN Steering Committee (SC). The SC is responsible for approving final decisions, establishing subcommittees, affirming their charters, and appointing subcommittee chairs. †Asian Health Services, CA; Charles B. Wang Community Health Center, NY; Waianae Coast Comprehensive Health Center, HI; Waimanalo Health Center, HI. ‡Erie Family Health Center, IL; Glide Health Services, CA; Heartland Health Outreach, IL; Howard Brown Health Center, IL; Near North, IL; North Country Health Care, AZ; PCC Community Wellness Center, IL. §Beaufort Jasper Hampton Comprehensive Health Services, SC; Chase Brexton Health Services, MD; Fenway Health, MA. ¶Multnomah County Health Department, OR; Richmond Clinic, OR; Open Door Community Health Center, CA; Virginia Garcia Memorial Health Center, OR. AAPCHO, Association of Asian Pacific Community Health Organizations; DCC, Data Coordinating Center at the Kaiser Permanente Center for Health Research, Portland, Oregon; UCLA, University of California, Los Angeles.
- Figure 2.
Insurance status. Baseline interaction of HbA1c with insurance status and diabetes status in the diabetes mellitus [DM] + cardiovascular disease [CVD] + depression [DEP] group (A) compared with DM-only group (B). For the DM + CVD + DEP group, baseline HbA1c did not differ among insurance groups, whereas for those with DM only, uninsured patients had higher baseline HbA1c.
- Figure 3.
Interactions of HbA1c with primary language and diabetes status in the diabetes mellitus [DM]–only group (A), the DM + cardiovascular disease [CVD] group (B), and the DM + CVD + depression [DEP] group (C). Among those for whom Spanish was the primary language, HbA1c declined over time to a greater degree in the DM + CVD (B) group compared to the DM-only group (A). For the DM + CVD + DEP group (C), Spanish speakers had lower baseline HbA1c than English speakers compared with the DM-only group (A), in which a baseline difference was not detected between English and Spanish speakers.
Tables
- Table 1.
International Classification of Diseases, 9th Revision Codes of Diabetes, Cardiovascular Disease, and Depression
Diagnosed Condition Primary Care Visit/Problem List ICD-9 Codes Diabetes Diabetes mellitus 250.xx Polyneuropathy in diabetes 357.2 Diabetic retinopathy 362.0 Background diabetic retinopathy 362.01 Proliferative diabetic retinopathy 362.02 Nonproliferative diabetic retinopathy NOS 362.03 Mild nonproliferative diabetic retinopathy 362.04 Moderate nonproliferative diabetic retinopathy 362.05 Severe nonproliferative diabetic retinopathy 362.06 Diabetic macular edema 362.07 Cardiovascular Disease Myocardial infarction 410.x, 412.x Congestive heart failure 428.x Peripheral vascular disease 443.9, 441.x, 785.4, V43.4 Cerebrovascular disease 430.x to 438.x Depression Major depressive affective disorder, single episode 296.2x Major depressive affective disorder, recurrent episode 296.3x Atypical depressive disorder 296.82 Depressive type psychosis 298.0 Dysthymic disorder 300.4 Chronic depressive personality disorder 301.12 Adjustment disorder with depressed mood 309.0 Prolonged depressive reaction 309.1 Adjustment disorder with mixed anxiety and depressed mood 309.28 Depressive disorder, not elsewhere classified 311 ICD-9, International Classification of Diseases, 9th Revision; NOS, not otherwise specified.
- Table 2.
Characteristics of Adult Community Health Applied Research Network Patients with at Least One Primary Care Visit per Year, for at Least 3 Consecutive Years, between January 1, 2006, and December 31, 2013 (N = 114,845)
Patients with Diabetes Patients without Diabetes Total n Col % n Col % n Col % Sex Male 7,426 42.8 33,943 34.8 41,369 36.0 Female 9,914 57.1 63,107 64.7 73,021 63.6 Transgender 20 0.1 430 0.4 450 0.4 Missing or unknown 0 0.0 5 0.0 5 0.0 Race/ethnicity Hispanic 3,212 18.5 17,263 17.7 20,475 17.8 Non-Hispanic white 4,378 25.2 29,103 29.9 33,481 29.2 Non-Hispanic black 1,740 10.0 11,368 11.7 13,108 11.4 Non-Hispanic Asian or Pacific Islander 7,444 42.9 34,802 35.7 42,246 36.8 Other* 502 2.9 4,261 4.3 4,763 4.1 Missing or unknown 84 0.5 688 0.7 772 0.7 Primary language English 8,284 47.7 48,877 50.1 57,161 49.8 Spanish 2,728 15.7 12,532 12.9 15,260 13.3 Cantonese or Mandarin 3,891 22.4 22,090 22.7 25,981 22.7 Other 1,689 9.8 6,246 6.4 7,935 6.9 Missing or unknown 768 4.4 7,740 7.9 8,508 7.4 ↵* Includes American Indian and multiracial. Col %, column percentages.
- Table 3.
Characteristics of Adult Patients with Diabetes in the Community Health Applied Research Network Who Had at Least One Primary Care Visit over at Least 3 Consecutive Years
DM Only (n = 13,790) DM + CVD (n = 817) DM + DEP (n = 2,495) DM + CVD + DEP (n = 258) Age in 2013 (years), mean (SD) 54.7 (13.4) 61.9 (12.5) 50.7 (12.2) 58.2 (10.7) Sex Male 6156 (45) 402 (49) 763 (31) 105 (41) Female 7624 (55) 415 (51) 1722 (69) 153 (59) Transgender 10 (<1) 0 (0) 10 (<1) 0< (0) Missing/unknown 0 (0) 0 (0) 0 (0) 0 (0) Race/ethnicity Hispanic 2682 (19) 63 (8) 453 (18) 14 (5) Non-Hispanic white 2912 (21) 246 (30) 1104 (44) 116 (45) Non-Hispanic black 1419 (10) 90 (11) 197 (8) 34 (13) Non-Hispanic Asian/Pacific Islander 6314 (46) 391 (48) 656 (26) 83 (32) Other* 289 (2) 13 (2) 39 (2) 4 (2) Missing/unknown 64 (1) 7 (1) 11 (0) 2 (1) Primary language English 5919 (43) 494 (61) 1677 (67) 194 (75) Spanish 2308 (17) 49 (6) 358 (14) 13 (5) Cantonese/Mandarin 3514 (26) 158 (19) 196 (8) 23 (9) Other 1395 (10) 71 (9) 203 (8) 20 (8) Missing/unknown 654 (5) 45 (6) 61 (2) 8 (3) Insurance status Continuously insured 7656 (56) 614 (75) 1478 (59) 195 (76) Continuously uninsured 2174 (16) 41 (5) 251 (10) 7 (3) Insurance gaps† 3476 (25) 145 (18) 747 (30) 55 (21) Missing or unknown 484 (4) 17 (2) 19 (1) 1 (0) Charlson index, mean (SD) 1.2 (0.8) 2.4 (1.0) 1.5 (1.1) 2.6 (1.4) Number of annual visits 1 or 2 1775 (13) 51 (6) 181 (7) 12 (5) 3 or 4 4902 (36) 207 (25) 565 (23) 40 (16) ≥5 7113 (52) 559 (68) 1749 (70) 206 (80) - Table 4.
Intercept Coefficients: Estimated Marginal Mean Differences in Average HbA1c Level at the Index Date*
Category for Intercept Differences for Mean HbA1c Fixed Effects β Coefficient SE (β) P Value Linear Contrast P Values Node Grand mean at baseline (intercept)† 7.768 0.172 <.001 <.001 Mean HbA1c level difference, node 2 vs node 1 −0.577 0.113 <.001 Mean HbA1c level difference, node 3 vs node 1 −0.391 0.232 .123 Mean HbA1c level difference, node 4 vs node 1 −0.387 0.083 <.001 Age (at baseline) Each additional year of age −0.014 0.002 .001 NA Charlson index score Each additional Charlson index score point −0.091 0.031 .011 NA Sex Female vs male −0.231 0.040 <.001 NA Race/ethnicity Hispanic vs non-Hispanic white 0.137 0.112 .243 <.001 Non-Hispanic black vs non-Hispanic white 0.314 0.090 .004 Non-Hispanic Asian or Pacific Islander vs non-Hispanic white 0.015 0.087 .865 Non-Hispanic other vs non-Hispanic white 0.393 0.128 .009 Insurance status Continually uninsured vs continually insured 0.375 0.125 .010 .002 Insurance gaps vs continually insured 0.133 0.051 .022 Primary language Spanish vs English 0.035 0.145 .812 .009 Cantonese or Mandarin vs English −0.213 0.086 .028 Other language vs English 0.079 0.104 .457 Health care use‡ 3 or 4 Visits vs 1 or 2 visits 0.012 0.081 .889 .296 ≥5 Visits vs 1 or 2 visits 0.092 0.101 .383 ↵* This multilevel model predicted mean HbA1c level as a function of diabetes status, primary language, and insurance status, adjusting for age, Charlson index score, sex, race/ethnicity, and node.
↵† Assuming all other covariates equal zero.
↵‡ Average number of annual primary care visits.
NA, not available; SE, standard error.
- Table 5.
Slope Coefficients: Estimated Marginal Mean Differences in Average Change or Slope (Trajectory) of HbA1c Level for Every Unit Change in the Variable*
Category for Slope differences for mean HbA1c Fixed Effects β Coefficient SE (β) P Value Linear Contrast P Values Node Grand mean at baseline† 0.033 0.027 0.241 >.500 Mean HbA1c level difference, node 2 vs node 1 −0.006 0.021 0.795 Mean HbA1c level difference, node 3 vs node 1 0.015 0.040 0.723 Mean HbA1c level difference, node 4 vs node 1 0.006 0.017 0.711 Age (at baseline) Each additional year of age −0.003 0.000 <0.001 NA Charlson index score Each additional Charlson index score point −0.002 0.006 0.796 NA Sex Female vs male 0.016 0.009 0.075 NA Race/ethnicity Hispanic vs non-Hispanic white 0.052 0.028 0.087 .22 Non-Hispanic black vs non-Hispanic white −0.005 0.030 0.858 Non-Hispanic Asian or Pacific Islander vs non-Hispanic white −0.014 0.023 0.559 Non-Hispanic other vs non-Hispanic white −0.052 0.047 0.284 Insurance status Continually uninsured vs continually insured 0.054 0.021 0.024 .014 Insurance gaps vs continually insured −0.002 0.010 0.833 Primary language Spanish vs English −0.060 0.034 0.101 .052 Cantonese or Mandarin vs English 0.039 0.018 0.051 Other language vs English 0.019 0.027 0.479 Health care use‡ 3 or 4 Visits vs 1 or 2 visits −0.020 0.020 0.333 >.500 ≥5 Visits vs 1 or 2 visits −0.024 0.021 0.280 ↵* This multilevel model predicted mean HbA1c level as a function of diabetes status, primary language, and insurance status, adjusting for age, Charlson index score, sex, race/ethnicity, and node.
↵† Assuming all other covariates equal zero.
↵‡ Average number of annual primary care visits.
NA, not available; SE, standard error.
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