Article Figures & Data
Figures
- Figure 1.
Population process flow. Abbreviation: MTHA, Medicare Total Health Assessment.
Tables
Individual Social Needs Reponses below Indicate “Yes” Response for Social Need Financial strain(1 item) Ability to pay for basics such as food, housing, medical care, and heating rated as “very hard”, “hard” or “somewhat hard.” Food insecurity(2 items) Rated the following as “sometimes true” or “often true”: In the past 12 months, 1) worried food would run out before more could be bought or 2) worried food bought would not last and did not have money to get more. Housing instability(3 items) In the past 12 months (including now), any of the following three conditions occurred: 1) unable to pay the mortgage or rent on time, 2) lived in 3 or more places or 3) did not have a steady place to sleep or slept in a shelter. Social isolation(1 item) Respondent felt lonely or isolated from people around them “sometimes,” “always,” or “often.” Transportation needs(2 items) In the past 12 months, lack of transportation: 1) kept respondent from medical appointments or from getting medications or 2) kept respondent from meetings, work, or from getting things needed for daily living. Population Measures Total Population (n = 1,954) Demographic measures Age, N (%) 65 to 74 1,203 (61.6%) 75 to 84 641 (32.8%) 85+ 110 (5.6%) Mean ± SD 73.7 ± 5.7 Sex, N (%) Female 938 (48.0%) Male 1,016 (52.0%) Race/Ethnicity, N (%) Asian/Asian-American 53 (2.7%) Black/African-American 30 (1.5%) Hawaiian or Pacific Islander 3 (0.2%) Hispanic/Latinx 64 (3.3%) Native American or Alaska Native 4 (0.2%) White, non-Hispanic 1,734 (88.7%) More than one race/ethnicity or other race/ethnicity 66 (3.4%) Socioeconomic and education status Neighborhood Deprivation Index (NDI, mean ± SD; min = −1.7788, max = 2.9605) −0.2 ± 0.6 NDI categories, N (%) Least deprivation (−1.7788 through −0.6141) 550 (28.2%) Moderate deprivation (−0.6136 through −0.1673) 651 (33.3%) Highest deprivation (−0.1667 through 2.9605) 753 (38.5%) Highest education level, N (%) High school or less 480 (24.6%) Some college or 2-year degree 776 (39.7%) College graduate or higher 698 (35.7%) Clinical characteristics HbA1c; 1st value in the 12 months before index date (N, %) HbA1c < 8% 1,663 (85.1%) HbA1c ≥ 8% 291 (14.9%) Years on T2DM Registry before index date (mean ± SD; min = 1.0 max = 29.2) 11.4 ± 7.1 Self-reported general health, N, (%) Fair/poor 588 (30.1%) Good, very good, excellent 1,366 (69.9%) Self-reported mental health, N (%) Fair/poor 363 (18.6%) Good, very good, excellent 1,591 (81.4% Comorbidities and prior health care utilization Charlson Co-morbidity Index, N (%) 0 393 (20.1%) 1 363 (18.6%) 2+ 1,198 (61.3%) Prior DM-specific ED utilization N (%) 1+ DM-related ED visits in 12 months before index date 381 (19.5%) 0 DM-related ED visits in 12 months before index date 1,573 (80.5%) Prior DM-specific hospital utilization, N (%) 1+ DM-related hospital admissions in 12 months prior 181 (9.3%) 0 DM-related hospital admissions in 12 months prior 1,773 (90.7%) Abbreviations: ED, Emergency Department; DM, Diabetes Mellitus; NDI, Neighborhood Deprivation Index; T2DM, Type 2 Diabetes Mellitus.
Need Characteristics N (%) Individual needs identified on MTHA Financial strain 187 (9.6%) Food insecurity 95 (4.9%) Housing instability 61 (3.1%) Social isolation 605 (31.0%) Transportation needs 131 (6.7%) Number of needs identified on MTHA 0 1,174 (60.1%) 1 580 (29.7%) 2 132 (6.8%) 3+ 68 (3.5%) Total needs (mean ± SD) 0.6 ± 0.8 Outcome Measures (1-year post Index Date) N (%) HbA1c < 8% 1,578 (80.8%) Any DM-specific ED utilization 456 (23.3%) Any DM-specific Hospital admissions 224 (11.5%) Abbreviations: MTHA, Medicare Total Health Assessment; ED, emergency department; DM, Diabetes Mellitus.
- Table 4.
Logistic Regression Results: Association Between Individual Social Needs and DM-Specific Outcomes
Hb A1c < 8% DM-Specific ED Utilization DM-Specific Hospital Admissions Logistic Regression Models Or 95% CI Or 95% CI Or 95% CI Individual social needs (yes vs no) Model 1: Financial Strain 0.56 0.36-0.85 1.65 1.17-2.33 1.77 1.17-2.68 Model 2: Food Insecurity 0.47 0.28-0.81 1.62 1.02-2.57 1.20 0.67-2.17 Model 3: Housing Instability 0.50 0.25-0.99 2.14 1.23-3.75 0.80 0.35-1.81 Model 4: Social Isolation 0.91 0.67-1.24 1.36 1.06-1.74 1.05 0.76-1.46 Model 5: Transportation Needs 1.06 0.63-1.80 1.83 1.23-2.71 1.34 0.81-2.21 1Models adjusted for age, sex, race/ethnicity, NDI, education level, prior HbA1c status (≤8), years on T2DM Registry, self-reported general (overall) health, self-reported mental health, CCI, prior DM-specific ED visits and prior DM-specific hospital admissions.
Abbreviations: ED, Emergency Department; DM, Diabetes Mellitus; CCI, Charlson Comorbidity Index; NDI, Neighborhood Deprivation Index.
