County-Level Socioeconomic Disparities in Use of Medical Services for Management of Infections by Medicare Beneficiaries With Diabetes-United States, 2012
County-Level Socioeconomic Disparities in Use of Medical Services for Management of Infections by Medicare Beneficiaries With Diabetes-United States, 2012
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DOI：
10.1097/phh.0000000000000800
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发表时间：
2019-07-01
影响因子：
3.3
通讯作者：
Truman, Benedict I.
中科院分区：
文献类型：
--
作者：
Chang, Man-Huei;Beckles, Gloria L.;Truman, Benedict I.
目的：评估2012年期间有按服务付费医疗保险索赔的糖尿病医疗保险受益人（MBWD）在医疗服务使用方面的县级社会经济差异。设计：我们使用医疗保险索赔数据来计算感染MBWD的百分比。背景：医疗保险受益人。参会人员：我们估计了MBWD的百分比谁使用医疗服务的3组感染的性别和五分之一的流行率的人的居住县的社会因素：解剖部位特异性感染;病原体特异性感染;和HHST感染（人类免疫缺陷病毒/获得性免疫缺陷综合征，病毒性肝炎，性传播疾病和结核病）。主要结局指标：使用县特定的社会经济决定因素的五分位数，我们计算了男性和女性MBWD感染的绝对和相对差异。我们还使用基于回归的汇总测量来估计每个感染组的总体平均绝对和相对差异。结果：在450万男性MBWD中，分别有15.8%、25.3%和2.7%的人有1种或多种位点特异性、病原体特异性和HHST感染。女性的结果相似（n = 520万）。随着MBWD居住县的社会不利因素增加，每个群体中有1个或多个感染的MBWD的百分比增加。在接受1次或1次以上感染（部位或病原体特异性）的医疗服务方面，县级社会经济差距的绝对和相对比例分别为12.9个百分点或更低和65.5%或更低。对于HHST感染，居住在最高五分位数（Q5）的人中有1个或多个HHST感染的MBWD百分比比居住在最低五分位数（Q1）的人高3至4倍（P <0.001）。结论：MBWD的感染负担通常与县级环境社会经济劣势相关，健康差异的程度因感染类别、社会经济因素和社会经济劣势的五分位数而异。这些发现意味着需要继续努力，以确定有效的干预措施，减少县级糖尿病患者感染的社会差距。
Objective: To assess county-level socioeconomic disparities in medical service usage for infections among Medicare beneficiaries with diabetes (MBWDs) who had fee-for-service health insurance claims during 2012. Design: We used Medicare claims data to calculate percentage of MBWDs with infections. Setting: Medicare beneficiaries. Participants: We estimated the percentage of MBWDs who used medical services for each of 3 groups of infections by sex and quintiles of the prevalence of social factors in the person's county of residence: anatomic site-specific infections; pathogen-specific infections; and HHST infections (human immunodeficiency virus/acquired immunodeficiency syndrome, viral hepatitis, sexually transmitted diseases, and tuberculosis). Main Outcome Measures: Using quintiles of county-specific socioeconomic determinants, we calculated absolute and relative disparities in each group of infections for male and female MBWDs. We also used regression-based summary measures to estimate the overall average absolute and relative disparities for each infection group. Results: Of the 4.5 million male MBWDs, 15.8%, 25.3%, and 2.7% had 1 or more site-specific, pathogen-specific, and HHST infections, respectively. Results were similar for females (n = 5.2 million). The percentage of MBWDs with 1 or more infections in each group increased as social disadvantage in the MBWDs' county of residence increased. Absolute and relative county-level socioeconomic disparities in receipt of medical services for 1 or more infections (site- or pathogen-specific) were 12.9 or less percentage points and 65.5% or less, respectively. For HHST infections, percentage of MBWDs having 1 or more HHST infections for persons residing in the highest quintile (Q5) was 3- to 4-fold higher (P < .001) than persons residing in the lowest quintile (Q1). Conclusions: Infection burden among MBWDs is generally associated with county-level contextual socioeconomic disadvantage, and the extent of health disparities varies by infection category, socioeconomic factor, and quintiles of socioeconomic disadvantage. The findings imply ongoing need for efforts to identify effective interventions for reducing county-level social disparities in infections among patients with diabetes.