Diabetes Care and Outcomes: Disparities Across Rural America
Diabetes Care and Outcomes: Disparities Across Rural America
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DOI：
10.1007/s10900-010-9259-0
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发表时间：
2010-08-01
影响因子：
5.9
通讯作者：
Probst, Janice C.
中科院分区：
文献类型：
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作者：
Hale, Nathan L.;Bennett, Kevin J.;Probst, Janice C.
我们使用2006年行为危险因素监测系统（BRFSS）的全国代表性数据，研究了农村和城市糖尿病患者接受糖尿病护理和选定结局的差异。“农村”被定义为居住在非大都市县。糖尿病护理变量包括医生访视、HbA 1c检测、足部检查和散瞳检查。结果变量为足溃疡和糖尿病视网膜病变。分析仅限于18岁及以上自我报告糖尿病诊断的人（n = 29，501）。在过去一年中，农村糖尿病患者报告散瞳检查（69.1 vs. 72.4%; P = 0.005）或足部检查（70.6 vs. 73.7%; P = 0.016）的比例低于城市糖尿病患者。相反，报告糖尿病视网膜病变（25.8%对22.0%; P = 0.007）和足部溃疡需要超过四周才能愈合（13.2%对11.2%; P = 0.036）的农村人群比例高于城市人群。在调整分析中考虑个体特征后，农村居住与接受服务无关，但仍与视网膜病变风险增加相关（OR = 1.20，95%CI = 1.02-1.42）。参与糖尿病自我管理教育（DSME）与研究中包括的所有糖尿病护理措施呈正相关。专业服务的提供和旅行方面的考虑可以解释其中的一些差异。
We examined differences in receipt of diabetes care and selected outcomes between rural and urban persons living with diabetes, using nationally representative data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS). "Rural" was defined as living in a non-metropolitan county. Diabetes care variables were physician visit, HbA1c testing, foot examination, and dilated eye examination. Outcome variables were presence of foot sores and diabetic retinopathy. Analysis was limited to persons 18 and older self-reporting a diagnosis of diabetes (n = 29,501). A lower proportion of rural than urban persons with diabetes reported a dilated eye examination (69.1 vs. 72.4%; P = 0.005) or a foot examination in the past year (70.6 vs. 73.7%; P = 0.016). Conversely, a greater proportion of rural than urban persons reported diabetic retinopathy (25.8 vs. 22.0%; P = 0.007) and having a foot sore taking more than four weeks to heal (13.2 vs. 11.2%; P = 0.036). Rural residence was not associated with receipt of services after individual characteristics were taken into account in adjusted analysis, but remained associated with an increased risk for retinopathy (OR = 1.20, 95% CI = 1.02-1.42). Participation in Diabetes Self-Management Education (DSME) was positively associated with all measures of diabetes care included in the study. Availability of specialty services and travel considerations could explain some of these differences.