Beau Blass, Hannah Mahoney, Jay B Lusk, Amy G Clark, Leonor Corsino, Bradley G Hammill
{"title":"社区剥夺和综合糖尿病护理的质量：来自美国医疗保险优势参保者的全国性回顾性队列研究的结果。","authors":"Beau Blass, Hannah Mahoney, Jay B Lusk, Amy G Clark, Leonor Corsino, Bradley G Hammill","doi":"10.1136/bmjopen-2024-092971","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the association between neighbourhood socioeconomic deprivation and outcomes reflecting comprehensive diabetes care (CDC).</p><p><strong>Design: </strong>Retrospective cohort study SETTING: US Medicare Advantage (MA) data, 2015-2020.</p><p><strong>Participants: </strong>National sample of MA enrollees with diabetes.</p><p><strong>Outcome measures: </strong>Primary outcomes included six indicators of CDC from the Healthcare Effectiveness Data and Information Set: haemoglobin (Hb) A1c (HbA1c) testing, HbA1c control (<8%), HbA1c poor control (>9%), blood pressure control (<140/90 mm Hg), receipt of eye exams and medical attention for nephropathy.</p><p><strong>Results: </strong>There were 827 227 enrolments included in the final analysis. After adjusting for demographic (age, sex, race/ethnicity and dual eligibility) and regional characteristics (rurality and primary care providers per capita), high neighbourhood deprivation was associated only with worse glycaemic control (for HbA1c>9%, risk ratio (RR) 1.04, 95% CI 1.02 to 1.07). This relationship was significant for white and Asian patients (RR 1.08, 95% CI 1.05 to 1.11 and RR 1.18, 95% CI 1.05 to 1.32, respectively); outcomes for black and Hispanic patients were worse overall but independent of neighbourhood deprivation (RR 1.00, 95% CI 0.96 to 1.05 and RR 0.98, 95% CI 0.94 to 1.03, respectively). In the fully adjusted model, neighbourhood deprivation was not associated with measures that directly reflect access to care, including the occurrence of HbA1c testing and receipt of eye exams (RR 0.99, 95% CI 0.94 to 1.04 and RR 1.03, 95% CI 1.00 to 1.05).</p><p><strong>Conclusions: </strong>An increased risk of poor glycaemic control was observed for patients from areas of high neighbourhood deprivation, independent of individual socioeconomic status. Neighbourhood factors and their intersection with racial and ethnic disparities are important considerations for achieving equity in diabetes care.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 7","pages":"e092971"},"PeriodicalIF":2.3000,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306466/pdf/","citationCount":"0","resultStr":"{\"title\":\"Neighbourhood deprivation and quality of comprehensive diabetes care: findings from a national retrospective cohort study of US Medicare Advantage enrollees.\",\"authors\":\"Beau Blass, Hannah Mahoney, Jay B Lusk, Amy G Clark, Leonor Corsino, Bradley G Hammill\",\"doi\":\"10.1136/bmjopen-2024-092971\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This study aims to assess the association between neighbourhood socioeconomic deprivation and outcomes reflecting comprehensive diabetes care (CDC).</p><p><strong>Design: </strong>Retrospective cohort study SETTING: US Medicare Advantage (MA) data, 2015-2020.</p><p><strong>Participants: </strong>National sample of MA enrollees with diabetes.</p><p><strong>Outcome measures: </strong>Primary outcomes included six indicators of CDC from the Healthcare Effectiveness Data and Information Set: haemoglobin (Hb) A1c (HbA1c) testing, HbA1c control (<8%), HbA1c poor control (>9%), blood pressure control (<140/90 mm Hg), receipt of eye exams and medical attention for nephropathy.</p><p><strong>Results: </strong>There were 827 227 enrolments included in the final analysis. After adjusting for demographic (age, sex, race/ethnicity and dual eligibility) and regional characteristics (rurality and primary care providers per capita), high neighbourhood deprivation was associated only with worse glycaemic control (for HbA1c>9%, risk ratio (RR) 1.04, 95% CI 1.02 to 1.07). This relationship was significant for white and Asian patients (RR 1.08, 95% CI 1.05 to 1.11 and RR 1.18, 95% CI 1.05 to 1.32, respectively); outcomes for black and Hispanic patients were worse overall but independent of neighbourhood deprivation (RR 1.00, 95% CI 0.96 to 1.05 and RR 0.98, 95% CI 0.94 to 1.03, respectively). In the fully adjusted model, neighbourhood deprivation was not associated with measures that directly reflect access to care, including the occurrence of HbA1c testing and receipt of eye exams (RR 0.99, 95% CI 0.94 to 1.04 and RR 1.03, 95% CI 1.00 to 1.05).</p><p><strong>Conclusions: </strong>An increased risk of poor glycaemic control was observed for patients from areas of high neighbourhood deprivation, independent of individual socioeconomic status. Neighbourhood factors and their intersection with racial and ethnic disparities are important considerations for achieving equity in diabetes care.</p>\",\"PeriodicalId\":9158,\"journal\":{\"name\":\"BMJ Open\",\"volume\":\"15 7\",\"pages\":\"e092971\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-07-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306466/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Open\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/bmjopen-2024-092971\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjopen-2024-092971","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
目的：本研究旨在评估社区社会经济剥夺与糖尿病综合护理（CDC）结果之间的关系。设计：回顾性队列研究设置：2015-2020年美国医疗保险优势（MA）数据。参与者：全国糖尿病MA受试者样本。结果测量：主要结果包括来自卫生保健有效性数据和信息集的6项CDC指标：血红蛋白（Hb） A1c （HbA1c）检测、HbA1c控制（9%）、血压控制(结果：最终分析纳入827227名入组患者。在调整了人口统计学（年龄、性别、种族/民族和双重资格）和区域特征（农村性和人均初级保健提供者）后，高邻里剥夺仅与较差的血糖控制相关（HbA1c为9%，风险比（RR） 1.04, 95% CI 1.02至1.07）。这种关系在白人和亚裔患者中具有显著性（RR分别为1.08,95% CI 1.05 ~ 1.11和RR 1.18, 95% CI 1.05 ~ 1.32）；黑人和西班牙裔患者的预后总体上更差，但与邻里剥夺无关（RR分别为1.00,95% CI 0.96至1.05和RR 0.98, 95% CI 0.94至1.03）。在完全调整的模型中，邻里剥夺与直接反映获得医疗服务的措施无关，包括糖化血红蛋白检测的发生和眼科检查的接受（RR 0.99, 95% CI 0.94至1.04,RR 1.03, 95% CI 1.00至1.05）。结论：观察到来自高邻里剥夺地区的患者血糖控制不良的风险增加，与个人社会经济地位无关。社区因素及其与种族和民族差异的交叉是实现糖尿病护理公平的重要考虑因素。
Neighbourhood deprivation and quality of comprehensive diabetes care: findings from a national retrospective cohort study of US Medicare Advantage enrollees.
Objective: This study aims to assess the association between neighbourhood socioeconomic deprivation and outcomes reflecting comprehensive diabetes care (CDC).
Design: Retrospective cohort study SETTING: US Medicare Advantage (MA) data, 2015-2020.
Participants: National sample of MA enrollees with diabetes.
Outcome measures: Primary outcomes included six indicators of CDC from the Healthcare Effectiveness Data and Information Set: haemoglobin (Hb) A1c (HbA1c) testing, HbA1c control (<8%), HbA1c poor control (>9%), blood pressure control (<140/90 mm Hg), receipt of eye exams and medical attention for nephropathy.
Results: There were 827 227 enrolments included in the final analysis. After adjusting for demographic (age, sex, race/ethnicity and dual eligibility) and regional characteristics (rurality and primary care providers per capita), high neighbourhood deprivation was associated only with worse glycaemic control (for HbA1c>9%, risk ratio (RR) 1.04, 95% CI 1.02 to 1.07). This relationship was significant for white and Asian patients (RR 1.08, 95% CI 1.05 to 1.11 and RR 1.18, 95% CI 1.05 to 1.32, respectively); outcomes for black and Hispanic patients were worse overall but independent of neighbourhood deprivation (RR 1.00, 95% CI 0.96 to 1.05 and RR 0.98, 95% CI 0.94 to 1.03, respectively). In the fully adjusted model, neighbourhood deprivation was not associated with measures that directly reflect access to care, including the occurrence of HbA1c testing and receipt of eye exams (RR 0.99, 95% CI 0.94 to 1.04 and RR 1.03, 95% CI 1.00 to 1.05).
Conclusions: An increased risk of poor glycaemic control was observed for patients from areas of high neighbourhood deprivation, independent of individual socioeconomic status. Neighbourhood factors and their intersection with racial and ethnic disparities are important considerations for achieving equity in diabetes care.
期刊介绍：
BMJ Open is an online, open access journal, dedicated to publishing medical research from all disciplines and therapeutic areas. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around fully open peer review and continuous publication, publishing research online as soon as the article is ready.
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