BRIEF REPORT
Leo Lester, MD; Dang Dinh, MS; Annie Larson, PhD; Andrew Suchocki, MD, MPH, FAAFP; Miguel Marino, PhD; Jennifer DeVoe, MD, DPhil; Nathalie Huguet, PhD
Corresponding Author: Nathalie Huguet, PhD; Department of Family Medicine, Oregon Health & Science University
Email: huguetn@ohsu.edu
DOI: 10.3122/jabfm.2024.240186R1
Keywords: Access to Care, Community Health Centers, Diabetes, Health Insurance, Insurance Coverage, Low-Income Population, Medicaid, Primary Health Care, Secondary Data Analysis, Social Determinants of Health
Dates: Submitted: 05-07-2024; Revised: 08-12-2024; Accepted: 08-26-2024
FINAL PUBLICATION: |HTML| |PDF|
BACKGROUND: To evaluate insurance instability (churn) among adults with diabetes receiving care at community-based health centers (CHCs).
METHODS: Retrospective cohort study using patients’ electronic health records data for 300,158 adults aged 19-64 with ≥3 ambulatory visits between 2014 and 2019 of which 39,542 churned out of insurance. Generalized estimating equation-based (GEE) logistic regression models were fitted to assess the odds of churning.
RESULTS: Among CHC patients, those with diabetes had 1.25 greater odds of churning than those without diabetes (aOR =1.25; 95%CI=1.18, 1.32). Among CHC patients with diabetes, the odds of churning were higher for those with uncontrolled diabetes, more complex medication regimens, and acute diabetes complication.
CONCLUSIONS: CHC patients with diabetes are more likely to experience insurance instability than those without diabetes. Outreach efforts to reduce the impact of the post-pandemic Medicaid disenrollment among patients with diabetes and lower income will be critical to reduce harmful health consequences.