Diabetes Burden and Access to Preventive Care in the Rural United States
Diabetes Burden and Access to Preventive Care in the Rural United States
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DOI：
10.1111/j.1748-0361.2009.00259.x
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发表时间：
2010-12-01
影响因子：
4.9
通讯作者：
McBride, Timothy M.
中科院分区：
文献类型：
--
作者：
Krishna, Santosh;Gillespie, Kathleen N.;McBride, Timothy M.
背景：国家数据库可用于调查糖尿病患病率和医疗保健使用情况。基于指南的护理可以减少糖尿病并发症和发病率。然而，关于农村居民糖尿病患病率和糖尿病护理指南依从性以及不同国家数据库是否提供类似结果的了解甚少。目的：研究糖尿病患病率和指南依从性的城乡差异，并比较行为风险因素监测系统（BRFSS）和医疗费用面板调查（MEPS）。对2001-2002年的数据按城乡状况进行了分析和比较。患病率计算为简单未调整，加权未调整，加权调整使用多变量方法。结果：在调整了年龄、BMI、保险覆盖范围和其他人口统计学特征后，发现农村居民糖尿病患病率略高，MEPS为7.9%，BRFSS为6.0%，BRFSS为7.6%，并持续存在（MEPS中调整后OR 1.16 [1.02-1.31]; BRFSS中调整后OR 1.19 [1.01-1.20]）。MEPS中的农村人不太可能接受年度眼科检查（aOR = 0.85）和足部检查（aOR = 0.89）。BRFSS中接受年度眼科检查（aOR = 0.88）、足部检查（aOR = 0.85）或糖尿病教育（aOR = 0.83）的农村居民比例显著（P <0.05）较低。结论：两个数据集的农村居民糖尿病患病率较高。虽然在统计上并不总是显著的，但农村地区的趋势是遵守指南的情况较少。
Context: National databases can be used to investigate diabetes prevalence and health care use. Guideline-based care can reduce diabetes complications and morbidity. Yet little is known about the prevalence of diabetes and compliance with diabetes care guidelines among rural residents and whether different national databases provide similar results.Purpose: To examine rural-urban differences in the prevalence of diabetes and compliance with guidelines, and to compare the Behavioral Risk Factor Surveillance System (BRFSS) and the Medical Expenditures Panel Survey (MEPS).Methods: Data for 2001-2002 were analyzed and compared by rural-urban status. Prevalence was calculated as simple unadjusted, weighted unadjusted, and weighted adjusted using a multivariate approach. Results from the 2 databases were compared.Findings: A slightly higher prevalence of diabetes among rural residents, 7.9% versus 6.0% in MEPS and 7.6% versus 6.6% in BRFSS, was found and persisted after adjustment for age, BMI, insurance coverage, and other demographic characteristics (adjusted OR 1.16 [1.02-1.31] in MEPS; 1.19 [1.01-1.20] in BRFSS). Rural persons in MEPS were less likely to receive an annual eye examination (aOR = 0.85) and a feet check (aOR = 0.89). A significantly (P < .05) smaller proportion of rural residents in BRFSS received an annual eye examination (aOR = 0.88), feet check (aOR = 0.85), or diabetes education (aOR = 0.83). Rural residents in both datasets were more likely to get a quarterly HbA1c test done.Conclusion: Rural residents in both datasets had higher prevalence of diabetes. Though not always statistically significant, the trend was to less guideline compliance in rural areas.