Comorbidities, Utilization, and Quality of Care as Predictors of Diabetes Complications

Winston Liaw; Omolola E Adepoju; Carlos G Fuentes; Jiangtao Luo; Bill Glasheen; Ben King; Ioannis Kakadiaris; Todd Prewitt; Pete Womack; Jess Dobbins; LeChauncy Woodard

doi:10.3122/jabfm.2025.250185R1

Article Figures & Data

Figures

Tables

Download figure
Open in new tab
Figure 1. Flow Diagram for the Analytic Sample.

Tables

Figures

View popup

Table 1. Baseline Characteristics, 2016-2020.

Parameter	2016	2017	2018	2019	2020	p-value
Demographics, n (%)
Sex						0.94
Male	20,876 (47.2)	20,558 (47.3)	18,866 (47.3)	17,103 (47.2)	15,186 (47.0)
Female	23,333 (52.8)	22,945 (52.7)	20,997 (52.7)	19,146 (52.8)	17,116 (53.0)
Age group						<0.001
65-69	11,477 (26.0)	8,831 (20.3)	6,257 (15.7)	4,133 (11.4)	2,688 (8.3)
70-74	13,170 (29.8)	13,217 (30.4)	12,258 (30.8)	11,328 (31.3)	9,957 (30.8)
75-79	9,880 (22.4)	10,611 (24.4)	10,447 (26.2)	9,994 (27.6)	9,154 (28.3)
80-84	5,723 (13.0)	6,253 (14.4)	6,278 (15.8)	6,164 (17.0)	6,034 (18.7)
85-89	2,818 (6.4)	3,148 (7.2)	3,150 (7.9)	3,141 (8.7)	3,021 (9.4)
90+	1,141 (2.6)	1,443 (3.3)	1,473 (3.7)	1,489 (4.1)	1,448 (4.5)
Race/Ethnicity						0.18
White	32,785 (74.2)	32,389 (74.5)	29,574 (74.2)	26,849 (74.1)	23,652 (73.2)
Black	8,408 (19.0)	8,222 (18.9)	7,661 (19.2)	7,022 (19.4)	6,471 (20.0)
Other	922 (2.1)	921 (2.1)	842 (2.1)	758 (2.1)	699 (2.2)
Asian	870 (2.0)	830 (1.9)	771 (1.9)	693 (1.9)	639 (2.0)
Hispanic	1,099 (2.5)	1,023 (2.4)	906 (2.3)	836 (2.3)	756 (2.3)
Native American	125 (0.3)	118 (0.3)	109 (0.3)	91 (0.3)	85 (0.3)
Primary language						<0.001
English	28,185 (63.8)	27,941 (64.2)	26,665 (66.9)	25,178 (69.5)	22,322 (69.1)
Spanish	2,063 (4.7)	1,933 (4.4)	1,701 (4.3)	1,570 (4.3)	1,363 (4.2)
Other	13,961 (31.6)	13,629 (31.3)	11,497 (28.8)	9,501 (26.2)	8,617 (26.7)
Dually eligible						<0.001
No	37,952 (85.9)	37,529 (86.3)	34,687 (87.0)	31,563 (87.1)	28,113 (87.0)
Yes	6,257 (14.2)	5,974 (13.7)	5,176 (13.0)	4,686 (12.9)	4,189 (13.0)
Rural						0.27
No	34,962 (79.1)	34,311 (78.9)	31,511 (79.1)	28,730 (79.3)	25,684 (79.5)
Yes	9,247 (20.9)	9,192 (21.1)	8,352 (21.0)	7,519 (20.7)	6,618 (20.5)
Continuous variables, mean (SE)
Diabetes Complications Severity Index	2.17 (0.01)	2.47 (0.01)	2.63 (0.01)	2.78 (0.01)	2.81 (0.01)	<0.001
Charlson Comorbidity Index	6.16 (0.01)	6.38 (0.01)	6.58 (0.01)	6.82 (0.01)	6.89 (0.01)	<0.001
Functional Comorbidity Index	3.84 (0.01)	3.88 (0.01)	3.92 (0.01)	4.09 (0.01)	3.96 (0.01)	<0.001
Last risk score: Medicare Advantage	1.31 (0.00)	1.38 (0.00)	1.41 (0.00)	1.46 (0.01)	1.48 (0.01)	<0.001
Last risk score: Prescription	1.19 (0.00)	1.24 (0.00)	1.22 (0.00)	1.23 (0.00)	1.20 (0.00)	<0.001
Total count: Annual emergency department claims	0.54 (0.01)	0.54 (0.01)	0.51 (0.01)	0.50 (0.01)	0.42 (0.01)	<0.001
Total count: Annual urgent care claims	0.08 (0.00)	0.09 (0.00)	0.10 (0.00)	0.11 (0.00)	0.12 (0.00)	<0.001
Total count: Annual outpatient claims	8.23 (0.05)	8.94 (0.06)	9.29 (0.07)	9.87 (0.08)	9.88 (0.11)	<0.001
Total count: Annual physician visit claims	6.03 (0.06)	7.00 (0.07)	7.60 (0.09)	7.91 (0.09)	7.30 (0.09)	<0.001
Total count: Annual inpatient admit claims	0.25 (0.00)	0.29 (0.00)	0.30 (0.00)	0.29 (0.00)	0.28 (0.00)	<0.001
Total count: Annual pharmacy claims	44.59 (0.15)	43.61 (0.15)	43.48 (0.17)	44.35 (0.17)	46.60 (0.18)	<0.001
Blood pressure < 140/90 quality measure not achieved	0.21 (0.00)	0.24 (0.00)	0.20 (0.00)	0.21 (0.00)	0.20 (0.00)	<0.001
Hemoglobin A1c < 9% quality measure not achieved	0 (omitted)	0.37 (0.00)	0.30 (0.00)	0.28 (0.00)	0.25 (0.00)	<0.001

SE = standard error

View popup

Table 2. Factors Associated with Diabetes Complications Severity Index.

Parameter	Model 1 IRR (SE)	Model 2 IRR (SE)	Model 3 IRR (SE)	Model 4 IRR (SE)
Data year (ref=2016)
2017	1.13 (0.01)*	1.09 (0.00)*	1.10 (0.01)*	1.10 (.01)*
2018	1.22 (0.01)*	1.12 (0.01)*	1.15 (.01)*	1.15 (.01)*
2019	1.30 (0.01)*	1.11 (0.01)*	1.19 (.01)*	1.19 (.01)*
2020	1.32 (0.01)*	1.13 (0.01)*	1.19 (.01)*	1.19 (.01)*
Sex (ref=male)
Female	0.86 (0.01)*	0.88 (0.00)*	0.84 (.00)*	0.84 (.00)*
Age group (ref=65-69)
70-74	1.08 (0.01)*	0.90 (0.01)*	1.09 (.01)*	1.09 (.01)*
75-79	1.21 (0.01)*	0.97 (0.01)*	1.21 (.01)*	1.25 (.01)*
80-84	1.34 (0.01)*	0.88 (0.01)*	1.34 (.01)*	1.38 (.01)*
85-89	1.47 (0.02)*	0.94 (0.01)*	1.45 (.01)*	1.50 (.02)*
90+	1.49 (0.02)*	0.82 (0.01)*	1.46 (.02)*	1.51 (.02)*
Race/Ethnicity (ref=white)
Black	1.06 (0.01)*	1.04 (0.01)*	1.08 (.01)*	1.08 (.01)*
Other	0.86 (0.02)*	0.95 (0.02)*	0.93 (.02)*	0.93 (.02)*
Asian	0.78 (0.02)*	0.93 (0.02)*	0.88 (.02)*	0.89 (.02)*
Hispanic	0.94 (0.02)*	0.99 (0.02)	0.98 (.02)	0.98 (.02)
Native American	1.08 (0.07)	1.05 (0.05)	1.02 (.06)	1.02 (.06)
Primary language spoken (ref=English)
Spanish	1.02 (0.02)	0.98 (0.01)	1.04 (.02)*	1.04 (.02)*
Other	0.95 (0.01)*	0.99 (0.01) *	0.99 (.01)*	0.99 (.01)*
Dually eligible (ref=no)
Yes	1.26 (0.01)*	1.07 (0.01)*	1.06 (.01)*	1.06 (.01)*
Rural residence (ref=no)
Yes	0.90 (0.01) *	0.95 (0.01) *	0.91 (.01)*	0.92 (.01)*
Charlson Comorbidity Index	-	1.18 (0.00) *
Functional Comorbidity Index	-	1.08 (0.00) *
Last risk score: Medicare Advantage	-	-	1.10 (.00)*	1.11 (.00)*
Last risk score: Prescription	-	-	1.09 (.00)*	1.09 (.00)*
Total count: Annual emergency department claims	-	-	1.01 (.00)*	1.01 (.00)*
Total count: Annual urgent care claims	-	-	1.01 (.00)*	1.01 (.00)*
Total count: Annual outpatient claims	-	-	1.003 (.00)*	1.003 (.00)*
Total count: Annual physician visit claims	-	-	1.003 (.00)*	1.003 (.00)*
Total count: Annual inpatient admit claims	-	-	1.07 (.00)*	1.07 (.00)*
Total count: Annual pharmacy claims	-	-	1.003 (.00)*	1.003 (.00)*
Blood pressure < 140/90 quality measure not achieved	-	-		1.10 (.01)*
Hemoglobin A1c < 9% quality measure not achieved	-	-		1.001 (.01)