Association of a housing based individual socioeconomic status measure with diabetic control in primary care practices
Association of a housing based individual socioeconomic status measure with diabetic control in primary care practices
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DOI：
10.1016/j.pcd.2021.10.001
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发表时间：
2022-02-08
影响因子：
2.9
通讯作者：
Garrison, Gregory M.
中科院分区：
文献类型：
--
作者：
Greenwood, Jason;Zurek, Kaitlyn, I;Garrison, Gregory M.
目的：社会经济地位(SES)是影响医疗结果的一个重要变量。然而，分组的SES数据并不总是代表所有成员，很难获得个别级别的数据。一种基于住房的有效个人住房措施已可用，但尚未在糖尿病患者中进行研究。我们假设，根据D5的测量，住在最低住房四分位数的患者与较差的糖尿病控制有关。方法：对明尼苏达州东南部5个以病人为中心的家庭医疗机构中的5463名糖尿病患者进行了回顾性队列研究。住房是一个经过验证的、标准化的、基于住房的SES衡量标准，它是根据可公开获得的县评估员办公室数据构建的。通过D5(HgbA1c<；8、BP<；140/90、他汀类药物使用、非吸烟状态和抗血小板治疗)评估糖尿病控制情况。结果：在最低四分位数中，D5失控的患者(56.4%)多于其他任何四分位数的患者(分别为49.2%、49.8%、49.6%，p<；0.001)。多变量分析显示，与第一个四分位数相比，第二、三或四分位数患者D5控制的调整后优势分别为1.28、1.21和1.20。结论：以房屋指数第一四分位数表示的较低的SES与较低的D5控制率和较差的糖尿病预后相关。使用House指数来识别以患者为中心的疗养院中的这些人，在决定将糖尿病控制工作集中在哪里可能被证明是有用的。
Aims: Socioeconomic status (SES) is an important variable that impacts healthcare outcomes. However, grouped SES data is not always representative of all members and it is difficult to obtain individual level data. A validated individual housing-based measure termed HOUSES is available, but has not been studied in diabetes. We hypothesize that patients in the lowest HOUSES quartile are associated with worse diabetic control as measured by the D5. Methods: A retrospective cohort study of 5463 patients with diabetes in 5 patient centered medical home practices in southeast Minnesota was conducted. HOUSES is a validated, standardized housing-based SES measure constructed from publicly available county assessor's office data. Diabetic control was assessed by the D5 (HgbA1c < 8, BP < 140/90, statin use, nonsmoking status, and antiplatelet therapy). Results: In the lowest HOUSES quartile, more patients had an uncontrolled D5 (56.4%) than any of the other quartiles (49.2%, 49.8%, 49.6% respectively, p < 0.001). A multivariate analysis shows the adjusted odds of D5 control for patients in the 2nd, 3rd or 4th HOUSES quartiles as opposed to the 1st quartile are 1.28, 1.21, and 1.20, respectively. Conclusion: Lower SES as represented by the first quartile of HOUSES index, is associated with lower odds of D5 control and thus worse diabetic outcomes. Using the HOUSES index to identify these individuals in a patient centered medical home might prove useful in deciding where to focus diabetic control efforts.