Percent and Adjusted Odds of Insurance Churning Among Patients With Diabetes Seen in Community-Based Health Centers from 2014 to 2019* - Excluding 42,722 Patients with a Single Uninsured from Those Who Did Not Churn
| Churned out of Insurance (N = 7,954) | Did not Churn out of Insurance (N = 29,821) | aOR of Churning (95% Cl) | |||
|---|---|---|---|---|---|
| N | Row % | N | Row % | ||
| Sex | |||||
| Female | 4,970 | 23.4 | 16,277 | 76.6 | Reference |
| Male | 2,984 | 18.1 | 13,544 | 81.9 | 0.78 (0.72, 0.85) |
| Age | |||||
| 19-44 | 2,421 | 21.6 | 8,782 | 78.4 | Reference |
| 45-64 | 5,533 | 20.8 | 21,039 | 79.2 | 0.88 (0.82, 0.94) |
| Race/Ethnicity | |||||
| Non-Hispanic White | 1,694 | 14.3 | 10,155 | 85.7 | Reference |
| Hispanic | 3,897 | 26.1 | 11,037 | 73.9 | 1.84 (1.51, 2.25) |
| Non-Hispanic Black | 1,803 | 24.1 | 5,675 | 75.9 | 1.67 (1.41, 1.99) |
| Non-Hispanic Other | 266 | 14.8 | 1,536 | 85.2 | 0.97 (0.81, 1.16) |
| Missing | 294 | 17.2 | 1,418 | 82.8 | 1.21 (1.03, 1.43) |
| Baseline payor type | |||||
| Medicaid | 4,464 | 17.9 | 20,502 | 82.1 | Reference |
| Private | 3,490 | 27.2 | 9,319 | 72.8 | 2.00 (1.71, 2.33) |
| Federal poverty level | |||||
| ≤138% | 6,354 | 22.3 | 22,091 | 77.7 | 1.37 (1.17, 1.59) |
| >138% | 1,276 | 20 | 5,109 | 80 | Reference |
| Missing | 324 | 11 | 2,621 | 89 | 0.65 (0.42, 0.99) |
| Patients’ residence | |||||
| Rural | 1,566 | 18.3 | 6,970 | 81.7 | Reference |
| Urban | 6,388 | 21.8 | 22,851 | 78.2 | 1.14 (0.86, 1.51) |
| Comorbidities excluding diabetes | |||||
| Mental health disorder only | 310 | 19.3 | 1,298 | 80.7 | 0.99 (0.82, 1.20) |
| Physical comorbidity only | 4,423 | 22.7 | 15,093 | 77.3 | 1.06 (0.97, 1.15) |
| Mental health and physical comorbidity | 1,864 | 18.7 | 8,128 | 81.3 | 0.91 (0.81, 1.02) |
| None | 1,357 | 20.4 | 5,302 | 79.6 | Reference |
| Mean ambulatory visits, (SD) | 19.5 | 15.7 | 16.4 | 12.2 | 1.02 (1.01, 1.02) |
| HbA1c control | |||||
| ≤9 | 5,343 | 19.4 | 22,168 | 80.6 | Reference |
| >9 | 2,465 | 26.5 | 6,850 | 73.5 | 1.40 (1.30, 1.50) |
| Missing | 146 | 15.4 | 803 | 84.6 | 1.12 (0.88, 1.43) |
| Diabetes medication regimen complexity | |||||
| No medication | 146 | 15.4 | 803 | 84.6 | Reference |
| Lower complexity | 4,874 | 21.3 | 1,7979 | 78.7 | 1.38 (1.26, 1.51) |
| High complexity | 2,134 | 24.9 | 6,431 | 75.1 | 1.39 (1.23, 1.58) |
| Ever with insulin | |||||
| Yes | 3,496 | 23.5 | 11,411 | 76.5 | 1.05 (0.97, 1.13) |
| No | 4,458 | 19.5 | 18,410 | 80.5 | Reference |
| Acute complications during study period | |||||
| 0 | 6,614 | 20.5 | 25,713 | 79.5 | Reference |
| 1 | 807 | 25.7 | 2,327 | 74.3 | 1.19 (1.06 1.33) |
| ≥2 | 533 | 23 | 1,781 | 77 | 0.97 (0.84, 1.13) |
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. Those with one uninsured visit among those who did not churn were excluded. Chi-square tests for categorical variables and t-tests for continuous variables were used to assess differences between churning groups, except for age groups, all were significant at p < .001.
Bolded estimates are significant at p < .05.