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Brief ReportBrief Report

Relationship Between Social Risks and Diabetes Metrics in a US Health System

Jessica L. Sosso, Karen M. Fischer, Michelle A. Lampman, Gregory M. Garrison, Stephen K. Stacey, Matthew E. Bernard, Randy M. Foss, Dominika A. Jegen, Summer V. Allen and Tom D. Thacher
The Journal of the American Board of Family Medicine September 2024, 37 (5) 939-947; DOI: https://doi.org/10.3122/jabfm.2023.230498R2
Jessica L. Sosso
From the Department of Family Medicine, Mayo Clinic Health System, Sparta, WI (JLS); Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN (KMF); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (MAL); Department of Family Medicine, Mayo Clinic, Rochester, MN (GMG, MEB, SVA, TDT); Department of Family Medicine, Mayo Clinic Health System, La Crosse, WI (SKS); Department of Family Medicine, Mayo Clinic Health System, Lake City, MN (RMF); Department of Family Medicine, Mayo Clinic Health System, Owatonna, MN (DAJ).
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Karen M. Fischer
From the Department of Family Medicine, Mayo Clinic Health System, Sparta, WI (JLS); Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN (KMF); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (MAL); Department of Family Medicine, Mayo Clinic, Rochester, MN (GMG, MEB, SVA, TDT); Department of Family Medicine, Mayo Clinic Health System, La Crosse, WI (SKS); Department of Family Medicine, Mayo Clinic Health System, Lake City, MN (RMF); Department of Family Medicine, Mayo Clinic Health System, Owatonna, MN (DAJ).
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Michelle A. Lampman
From the Department of Family Medicine, Mayo Clinic Health System, Sparta, WI (JLS); Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN (KMF); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (MAL); Department of Family Medicine, Mayo Clinic, Rochester, MN (GMG, MEB, SVA, TDT); Department of Family Medicine, Mayo Clinic Health System, La Crosse, WI (SKS); Department of Family Medicine, Mayo Clinic Health System, Lake City, MN (RMF); Department of Family Medicine, Mayo Clinic Health System, Owatonna, MN (DAJ).
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Gregory M. Garrison
From the Department of Family Medicine, Mayo Clinic Health System, Sparta, WI (JLS); Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN (KMF); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (MAL); Department of Family Medicine, Mayo Clinic, Rochester, MN (GMG, MEB, SVA, TDT); Department of Family Medicine, Mayo Clinic Health System, La Crosse, WI (SKS); Department of Family Medicine, Mayo Clinic Health System, Lake City, MN (RMF); Department of Family Medicine, Mayo Clinic Health System, Owatonna, MN (DAJ).
MD
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Stephen K. Stacey
From the Department of Family Medicine, Mayo Clinic Health System, Sparta, WI (JLS); Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN (KMF); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (MAL); Department of Family Medicine, Mayo Clinic, Rochester, MN (GMG, MEB, SVA, TDT); Department of Family Medicine, Mayo Clinic Health System, La Crosse, WI (SKS); Department of Family Medicine, Mayo Clinic Health System, Lake City, MN (RMF); Department of Family Medicine, Mayo Clinic Health System, Owatonna, MN (DAJ).
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Matthew E. Bernard
From the Department of Family Medicine, Mayo Clinic Health System, Sparta, WI (JLS); Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN (KMF); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (MAL); Department of Family Medicine, Mayo Clinic, Rochester, MN (GMG, MEB, SVA, TDT); Department of Family Medicine, Mayo Clinic Health System, La Crosse, WI (SKS); Department of Family Medicine, Mayo Clinic Health System, Lake City, MN (RMF); Department of Family Medicine, Mayo Clinic Health System, Owatonna, MN (DAJ).
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Randy M. Foss
From the Department of Family Medicine, Mayo Clinic Health System, Sparta, WI (JLS); Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN (KMF); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (MAL); Department of Family Medicine, Mayo Clinic, Rochester, MN (GMG, MEB, SVA, TDT); Department of Family Medicine, Mayo Clinic Health System, La Crosse, WI (SKS); Department of Family Medicine, Mayo Clinic Health System, Lake City, MN (RMF); Department of Family Medicine, Mayo Clinic Health System, Owatonna, MN (DAJ).
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Dominika A. Jegen
From the Department of Family Medicine, Mayo Clinic Health System, Sparta, WI (JLS); Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN (KMF); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (MAL); Department of Family Medicine, Mayo Clinic, Rochester, MN (GMG, MEB, SVA, TDT); Department of Family Medicine, Mayo Clinic Health System, La Crosse, WI (SKS); Department of Family Medicine, Mayo Clinic Health System, Lake City, MN (RMF); Department of Family Medicine, Mayo Clinic Health System, Owatonna, MN (DAJ).
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Summer V. Allen
From the Department of Family Medicine, Mayo Clinic Health System, Sparta, WI (JLS); Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN (KMF); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (MAL); Department of Family Medicine, Mayo Clinic, Rochester, MN (GMG, MEB, SVA, TDT); Department of Family Medicine, Mayo Clinic Health System, La Crosse, WI (SKS); Department of Family Medicine, Mayo Clinic Health System, Lake City, MN (RMF); Department of Family Medicine, Mayo Clinic Health System, Owatonna, MN (DAJ).
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Tom D. Thacher
From the Department of Family Medicine, Mayo Clinic Health System, Sparta, WI (JLS); Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN (KMF); Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN (MAL); Department of Family Medicine, Mayo Clinic, Rochester, MN (GMG, MEB, SVA, TDT); Department of Family Medicine, Mayo Clinic Health System, La Crosse, WI (SKS); Department of Family Medicine, Mayo Clinic Health System, Lake City, MN (RMF); Department of Family Medicine, Mayo Clinic Health System, Owatonna, MN (DAJ).
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  • Article
  • Figures & Data
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Article Figures & Data

Tables

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    Table 1.

    Association Between Patient Characteristics and D5 Metric Among Mayo Clinic and MCHS Patients with Type 2 Diabetes, 2022

     D5 Unmet
    (n = 24,557)
    D5 Met
    (n = 19,453)
    Total
    (n = 44,010)
    P-value
    Age   <0.0001*
     Mean (SD)64.7 (13.60)67.7 (13.66)66.0 (13.71) 
    ACG Risk score   0.7144*
     Mean (SD)2.8 (3.06)2.8 (2.91)2.8 (3.00) 
    Gender, n (%)   0.6660†
     Woman11,187 (55.9%)8,812 (44.1%)19,999 (45.4%) 
     Man13,369 (55.7%)10,639 (44.3%)24,008 (54.6%) 
     Nonbinary1 (50.0%)1 (50.0%)2 (0.0%) 
     Unknown0 (0.0%)1 (100.0%)1 (0.0%) 
    Race, n (%)   <0.0001†
     American Indian/Alaskan Native135 (64.0%)76 (36.0%)211 (0.5%) 
     Asian609 (57.0%)460 (43.0%)1,069 (2.4%) 
     Black760 (68.3%)352 (31.7%)1,112 (2.5%) 
     Other287 (65.5%)151 (34.5%)438 (1.0%) 
     Pacific Islander33 (51.6%)31 (48.4%)64 (0.1%) 
     Unknown215 (61.8%)133 (38.2%)348 (0.8%) 
     White22,518 (55.2%)18,250 (44.8%)40,768 (92.6%) 
    Insurance type, n (%)   <0.0001†
     Commercial5,972 (58.9%)4,171 (41.1%)10,143 (23.0%) 
     Government16,573 (54.7%)13,732 (45.3%)30,305 (68.9%) 
     Mayo insured1,715 (54.4%)1,439 (45.6%)3,154 (7.2%) 
     Unknown297 (72.8%)111 (27.2%)408 (0.9%) 
    Outpatient visits 2022<0.0001*
     Mean (SD)3.4 (4.96)3.7 (5.50)3.5 (5.21)
    Practice region, n (%)   0.0166†
     A5,693 (54.6%)4,731 (45.4%)10,424 (23.7%) 
     B5,295 (55.5%)4,251 (44.5%)9,546 (21.7%) 
     C6,293 (56.9%)4,769 (43.1%)11,062 (25.1%) 
     D3,507 (56.0%)2,760 (44.0%)6,267 (14.2%) 
     E3,769 (56.2%)2,942 (43.8%)6,711 (15.2%) 
    Urban/rural, n (%)0.037†
     Urban11,580 (55.3%)9,368 (44.7%)20,948 (47.6%)
     Rural12,973 (56.3%)10,084 (43.7%)23,057 (52.4%)
     Missing415
    • ↵*Kruskal-Wallis P-value; †Chi-Square p-value.

    • Percentages were calculated by row.

    • Abbreviation: SD, Standard deviation.

    • View popup
    Table 2.

    Association Between Social Risk Variables and D5 Metric Among Mayo Clinic and MCHS Patients with Type 2 Diabetes, 2022

     D5 Unmet
    (n = 24,557)
    D5 Met
    (n = 19,453)
    Total
    (n = 44,010)
    P-value
    Housing stability risk, n (%)   <0.0001*
     At risk1,675 (12.0%)891 (7.3%)2,566 (9.8%)
     Not at risk12,331 (88.0%)11,321 (92.7%)23,652 (90.2%) 
     Missing10,5517,24117,792 
    Financial strain risk, n (%)   <0.0001*
     High risk955 (6.3%)446 (3.4%)1,401 (4.9%)
     Medium risk2,292 (15.0%)1,429 (10.8%)3,721 (13.1%) 
     Low risk11,988 (78.7%)11,305 (85.8%)23,293 (82.0%) 
     Missing9,3226,27315,595 
    Food insecurity, n (%)   <0.0001*
     At risk1,761 (11.9%)861 (6.7%)2,622 (9.5%)
     Not at risk13,036 (88.1%)12,006 (93.3%)25,042 (90.5%) 
     Missing9,7606,58616,346 
    Transportation needs, n (%)   <0.0001*
     Unmet needs848 (5.5%)400 (3.0%)1,248 (4.3%)
     No needs14,588 (94.5%)12,958 (97.0%)27,546 (95.7%) 
     Missing9,1216,09515,216 
    Intimate partner violence, n (%)   0.0003*
     At risk398 (2.7%)260 (2.1%)658 (2.4%)
     Not at risk14,176 (97.3%)12,422 (97.9%)26,598 (97.6%) 
     Missing9,9836,77116,754 
    • *Chi-Square P-value.

    • View popup
    Table 3.

    Logistic Regression Model Association of Patient-Reported Social Risk with Likelihood of Meeting D5 Metric Outcome Among Mayo Clinic and MCHS Patients with Type 2 Diabetes, 2022

    Univariate Logistic RegressionMultiple Logistic Regression†
    Social Risk Variable*Odds Ratio (95% CI)P-valueOdds Ratio (95% CI)P-value
    Housing risk
     At Risk vs Not at Risk††0.58 (0.53, 0.63)<0.0010.68 (0.62, 0.74)<0.001
    Financial strain risk
     High Risk vs Low Risk††0.50 (0.44, 0.56)<0.0010.60 (0.53, 0.68)<0.001
     Medium Risk vs Low Risk††0.66 (0.62, 0.71)<0.0010.74 (0.69, 0.79)<0.001
    Food insecurity
     At Risk vs Not at Risk††0.53 (0.49, 0.58)<0.0010.64 (0.59, 0.70)<0.001
    Transportation needs
     Unmet Needs vs Met Needs††0.53 (0.47, 0.60)<0.0010.62 (0.55, 0.70)<0.001
    Intimate partner violence
     At Risk vs Not at Risk††0.75 (0.64, 0.87)<0.0010.88 (0.75, 1.04)0.123
    • ↵*Separate models were run for each social risk variable with an outcome of meeting the D5 metric.

    • ↵†Adjusted for age, gender, race, campus/location, rurality, insurance, ACG complexity score, utilization (total family medicine outpatient visits in last year).

    • ↵†† Reference group, Odds Ratio = 1.

    • Abbreviation: CI, Class interval.

    • View popup
    Table 4.

    Correlations Between the Social Risk Variables Using Cramer’s V Test

    Social Risk VariablesHousing RiskFinancial RiskFood InsecurityTransportation NeedsIPV Risk
    Housing risk—0.3880.3740.2150.115
    Financial risk0.388—0.6030.2870.155
    Food insecurity0.3740.603—0.3020.140
    Transportation0.2150.2870.302—0.122
    IPV risk0.1150.1550.1400.122—
    • Cramer’s V > 0.3 is considered highly correlated.

    • Abbreviation: IPV, Intimate Partner Violence.

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The Journal of the American Board of Family     Medicine: 37 (5)
The Journal of the American Board of Family Medicine
Vol. 37, Issue 5
September-October 2024
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Relationship Between Social Risks and Diabetes Metrics in a US Health System
Jessica L. Sosso, Karen M. Fischer, Michelle A. Lampman, Gregory M. Garrison, Stephen K. Stacey, Matthew E. Bernard, Randy M. Foss, Dominika A. Jegen, Summer V. Allen, Tom D. Thacher
The Journal of the American Board of Family Medicine Sep 2024, 37 (5) 939-947; DOI: 10.3122/jabfm.2023.230498R2

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Relationship Between Social Risks and Diabetes Metrics in a US Health System
Jessica L. Sosso, Karen M. Fischer, Michelle A. Lampman, Gregory M. Garrison, Stephen K. Stacey, Matthew E. Bernard, Randy M. Foss, Dominika A. Jegen, Summer V. Allen, Tom D. Thacher
The Journal of the American Board of Family Medicine Sep 2024, 37 (5) 939-947; DOI: 10.3122/jabfm.2023.230498R2
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