| 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