Percent and Adjusted Odds of Insurance Churning Among Patients with Diabetes Seen in Community-Based Health Centers from 2014 to 2019*
| Churned out of Insurance (n = 7954) | Did Not Churn out of Insurance (n = 36,910) | aOR of Churning (95% CI) | |||
|---|---|---|---|---|---|
| N | Row % | N | Row % | ||
| Sex | |||||
| Female | 4,970 | 19.7 | 20,235 | 80.3 | Reference |
| Male | 2,984 | 15.2 | 16,675 | 84.8 | 0.78 (0.72, 0.84) |
| Age | |||||
| 19 to 44 | 2,421 | 18.3 | 10,832 | 81.7 | Reference |
| 45 to 64 | 5,533 | 17.5 | 26,078 | 82.5 | 0.87 (0.81, 0.93) |
| Race/Ethnicity | |||||
| Non-Hispanic White | 1,694 | 12.1 | 12,296 | 87.9 | Reference |
| Hispanic | 3,897 | 22.1 | 13,725 | 77.9 | 1.81 (1.50, 2.19) |
| Non-Hispanic Black | 1,803 | 19.8 | 7,305 | 80.2 | 1.58 (1.35, 1.85) |
| Non-Hispanic Other | 266 | 12.4 | 1,872 | 87.6 | 0.96 (0.81, 1.14) |
| Missing | 294 | 14.7 | 1,712 | 85.3 | 1.21 (1.04, 1.42) |
| Federal poverty level | |||||
| ≤138% | 6,354 | 18.7 | 27,595 | 81.3 | 1.33 (1.15, 1.54) |
| >138% | 1,276 | 16.9 | 6,283 | 83.1 | Reference |
| Missing | 324 | 9.7 | 3,032 | 90.3 | 0.68 (0.45, 1.03) |
| Patients’ residence | |||||
| Rural | 1,566 | 15.6 | 8,496 | 84.4 | Reference |
| Urban | 6,388 | 18.4 | 28,414 | 81.6 | 1.12 (0.87, 1.44) |
| Baseline payor type | |||||
| Medicaid | 4,464 | 15.0 | 25,306 | 85.0 | Reference |
| Private insurance | 3,490 | 23.1 | 11,604 | 76.9 | 1.94 (1.68, 2.25) |
| Comorbidities excluding diabetes | |||||
| Mental health disorder only | 310 | 16.1 | 1,616 | 83.9 | 0.99 (0.83, 1.18) |
| Physical comorbidity only | 4,423 | 19.1 | 18,708 | 80.9 | 1.08 (0.99, 1.17) |
| Mental health and physical comorbidity | 1,864 | 15.7 | 10,002 | 84.3 | 0.93 (0.84, 1.04) |
| None | 1,357 | 17.1 | 6,584 | 82.9 | Reference |
| Mean ambulatory visits, N (SD) | 19.5 | 15.7 | 16.9 | 12.8 | 1.01 (1.00, 1.01) |
| HbA1c control | |||||
| ≤9 | 5,343 | 16.4 | 2,7182 | 83.6 | Reference |
| >9 | 2,465 | 21.9 | 8,782 | 78.1 | 1.33 (1.24, 1.43) |
| Missing | 146 | 13.4 | 946 | 86.6 | 1.10 (0.87, 1.39) |
| Diabetes medication regimen complexity | |||||
| No medication | 946 | 12.7 | 6,498 | 87.3 | Reference |
| Lower complexity | 4,874 | 18.0 | 22,155 | 82.0 | 1.35 (1.24, 1.47) |
| High complexity | 2,134 | 20.5 | 8,257 | 79.5 | 1.33 (1.19, 1.49) |
| Ever with insulin | |||||
| Yes | 3,496 | 19.6 | 14,360 | 80.4 | 1.06 (0.98, 1.13) |
| No | 4,458 | 16.5 | 22,550 | 83.5 | Reference |
| Acute complications during study period | |||||
| 0 | 6,614 | 17.2 | 31,764 | 82.8 | Reference |
| 1 | 807 | 21.6 | 2,922 | 78.4 | 1.20 (1.08, 1.33) |
| ≥ 2 | 533 | 19.3 | 2,224 | 80.7 | 1.00 (0.87, 1.15) |
Abbreviations: aOR, Adjusted odds ratio, CI, Confidence interval.
*Sample included non-pregnant patients aged 19-64 without Medicare coverage who had a baseline insured visit between 2014 and 2017, with ≥3 ambulatory visits occurring within the subsequent 3-year period, and at least 12 months separating the first and last of these visits between 2014 and 2019. Those who churned were defined as having ≥2 consecutive uninsured visits. Those who did not churn included those who had every visit insured or those who had one single uninsured. χ2 tests for categorical variables and t test for continuous variables were used to test for differences between churning groups, except for age groups, all were significant at P <.001. Bolded estimates are significant at P < .05.