Abstract
Background:Lack of health insurance can adversely affect access to medical care which leads to poor disease outcome. Few studies examine the effects of no insurance on the development of diabetes complications. The objective of this study was to determine if there is an association between health insurance status and the outcome of complications among a group of diabetic patients admitted to a teaching hospital on the Texas-Mexico border.Methods:A retrospective case-control study was conducted over a one-year period. Multiple imputations were used to address missing values. We examined 82 diabetics who had one or more complications and 83 diabetic controls without complications. A complication was defined as a current skin or soft-tissue infection or a limb amputation. The main exposure was health insurance status, a three-level variable: no health insurance, Medicaid, and other insurance (referent). Logistic regression was used to calculate health insurance odds ratios (OR) adjusted for age, sex, and a history of recent trauma.Results:Patients with no health insurance were twice as likely to have a diabetic complication as patients in the referent category: adjusted OR = 2.22, P = 0.03. An association between Medicaid status and complications was not detected (adjusted OR = 1.16, P = 0.78).Conclusions:Not having health insurance was a risk factor for developing diabetic complications in a group of predominantly Hispanic patients.
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References
References1.DeNavas-Walt C, Proctor BD, Smith JC. US Census Bureau, Current Population Report. Income, Poverty, and Health Insurance Coverage in the United States: 2007, Washington, DC, US Government Printing Office, 2008, pp 60–235.2.American College of Physicians. No Health Insurance? It's Enough to Make You Sick. White Paper. Philadelphia, PA, American College of Physicians, 2000.3.Committee on the Consequences of Uninsurance. Care Without Coverage: Too Little, Too Late. The National Academy of Sciences, 2002.4.Committee on the Consequences of Uninsurance. Hidden Costs, Value Lost: Uninsurance in America. National Academy of Sciences, 2003.5.Wilper AP, Woolhandler S, Lasser KE, et al. A national study of chronic disease prevalence and access to care in uninsured U.S. adults. Ann Intern Med 2008;149:170–176.WilperAP]]WoolhandlerS]]LasserKE&etal;A national study of chronic disease prevalence and access to care in uninsured U.S. adults.Ann Intern Med2008149170-1766.Ayanian JZ, Kohler BA, Abe T, et al. The relationship between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med 1993;329:326–331.AyanianJZ]]KohlerBA]]AbeT&etal;The relationship between health insurance coverage and clinical outcomes among women with breast cancer.N Engl J Med1993329326-3317.Fowler-Brown A, Corbie-Smith G, Garrett J, et al. Risk of cardiovascular events and death—does insurance matter? J Gen Intern Med 2007;22:502–507.Fowler-BrownA]]Corbie-SmithG]]GarrettJ&etal;Risk of cardiovascular events and death—does insurance matter?J Gen Intern Med200722502-5078.Baker DW, Sudano JJ, Albert JM, et al. Lack of health insurance and decline in overall health in late middle age. N Engl J Med 2001;345:1106–1112.BakerDW]]SudanoJJ]]AlbertJM&etal;Lack of health insurance and decline in overall health in late middle age.N Engl J Med20013451106-11129.Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2007. Atlanta, GA, US Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.Centers for Disease Control and PreventionNational Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2007.Atlanta, GAUS Department of Health and Human Services, Centers for Disease Control and Prevention200810.American Diabetes Association. Economic costs of diabetes in the US in 2007. Diabetes Care 2008;31:1–20.American Diabetes AssociationEconomic costs of diabetes in the US in 2007.Diabetes Care2008311-2011.Gordois A, Scuffham P, Shearer A, et al. The healthcare costs of diabetic peripheral neuropathy in the US. Diabetes Care 2003;26:1790–1795.GordoisA]]ScuffhamP]]ShearerA&etal;The healthcare costs of diabetic peripheral neuropathy in the US.Diabetes Care2003261790-179512.Greenland S. Modeling and variable selection in epidemiologic analysis. Am J Public Health 1989;79:340–349.GreenlandSModeling and variable selection in epidemiologic analysis.Am J Public Health198979340-34913.Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. Philadelphia, PA, Lippincott Williams & Wilkins, 2008, ed 3.14.Little RJA, Rubin DB. Statistical Analysis with Missing Data. New York, Wiley, 2002, ed 2.15.Yuan YC. Multiple imputation for missing data: concepts and new development. Proceedings of the Twenty-Fifth Annual SAS Users Group International Conference. Cary, NC, SAS Institute, Inc., 2000, pp 1410–1419.YuanYCMultiple imputation for missing data: concepts and new development. Proceedings of the Twenty-Fifth Annual SAS Users Group International Conference.Cary, NCSAS Institute, Inc.20001410-141916.Harrell FE Jr. Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. New York, Springer, 2001.17.Horton NJ, Kleinman KP. Much ado about nothing: a comparison of missing data methods and software to fit incomplete data regression models. Am Stat 2007;61:79–90.HortonNJ]]KleinmanKPMuch ado about nothing: a comparison of missing data methods and software to fit incomplete data regression models.Am Stat20076179-9018.Kleinbaum DG, Kupper LL, Muller KE. Collinearity, in: Applied Regression Analysis and Other Multivariable Methods. Boston, MA, PWS-KENT Publishing Company, 1988, pp 206–217.KleinbaumDG]]KupperLL]]MullerKECollinearityApplied Regression Analysis and Other Multivariable Methods.Boston, MAPWS-KENT Publishing Company1988206-21719.Allison PD. Multicollinearity, in: Logistic Regression Using the SAS System: Theory and Application. Cary, NC, SAS Institute, Inc., 1999, pp 48–51.AllisonPDMulticollinearityLogistic Regression Using the SAS System: Theory and Application.Cary, NCSAS Institute, Inc.199948-5120.Nelson KM, Chapko MK, Reiber G, et al. The association between health insurance coverage and diabetes care; data from the 2000 Behavioral Risk Factor Surveillance System. Health Serv Res 2005;40:361–372.NelsonKM]]ChapkoMK]]ReiberG&etal;The association between health insurance coverage and diabetes care; data from the 2000 Behavioral Risk Factor Surveillance System.Health Serv Res200540361-37221.Songer TJ. Disability in diabetes, in: Diabetes in America. Washington, DC, US Government Printing Office, 1995, ed 2. National Diabetes Data Group. NIH Pub. No. 95–1468.22.Pugh JA, Tuley MR, Hazuda HP, et al. The influence of outpatient insurance coverage on the microvascular complications of non-insulin-dependent diabetes in Mexican Americans. J Diabetes Complications 1992;6:236–241.PughJA]]TuleyMR]]HazudaHP&etal;The influence of outpatient insurance coverage on the microvascular complications of non-insulin-dependent diabetes in Mexican Americans.J Diabetes Complications19926236-24123.County Fact Sheets. Selected Cancer Facts-El Paso County-2006. Texas Department of State Health Services. Available at: http://www.dshs.state.tx.us/tcr/factsheet_county.shtm. Accessed May 15, 2007.
