DISPARITIES IN UTILIZATION OF DIABETES COMPLICATIONS-RELATED PREVENTIVE SERVICES AMONG U.S. ADULTS WITH DIABETES: EVIDENCE FROM THE MEDICAL EXPENDITURE PANEL SURVEY (MEPS)
Author(s)
Gerald O. Ozota, BPharm, Marc L. Fleming, BS, MPH, RPh, PhD, Lawrence M. Brown, PhD;
Chapman University School of Pharmacy, Pharmaceutical Economics and Policy, Irvine, CA, USA
Chapman University School of Pharmacy, Pharmaceutical Economics and Policy, Irvine, CA, USA
OBJECTIVES: Diabetes-related complications such as neuropathy, retinopathy, nephropathy, and foot ulcers are largely preventable through the timely delivery of recommended preventive services. Despite established clinical guidelines, evidence suggests that disparities in the utilization of diabetes complication-related preventive services persist across sociodemographic groups in the United States. This study examined disparities in the utilization of diabetes complications preventive services among U.S. adults with diabetes
METHODS: A cross-sectional design, analyzing pooled data from the 2018-2022 Medical Expenditure Panel Survey. Adults aged ≥18 years who reported a diagnosis of diabetes were included. The primary outcome was receipt of all five recommended diabetes preventive services (≥2 A1c tests, eye examination, foot examination, cholesterol check, and influenza vaccination). Survey-weighted descriptive analyses estimated prevalence, and complex samples logistic regression was employed to assess factors associated with incomplete receipt of all five services, accounting for MEPS’s multistage sampling design
RESULTS: Among adults with diabetes, only 37.7% received all five recommended preventive services Education level, race/ethnicity, insurance category, sex, and age were significant predictors of receiving all five recommended diabetes preventive services (Adjusted Wald F p < .05). Higher educational level was strongly associated with increased service utilization; individuals with a master’s degree (OR = 0.19, 95% CI: 0.05-0.71) or doctorate degree (OR = 0.21, 95% CI: 0.05-0.82) had substantially lower odds of missing services. Although the overall race/ethnicity effect was significant (p = .002), pairwise comparisons did not reach statistical significance. Females had greater odds of not receiving all services compared with males (OR = 0.84, 95% CI: 0.67-0.98). Increasing age was associated with higher service uptake (B = −0.31, p < .001)
CONCLUSIONS: Persistent disparities by education, insurance status, and race/ethnicity highlight inequities in access to high-quality diabetes care. Targeted policy and health system interventions are necessary to enhance equitable access to diabetes preventive care and mitigate avoidable diabetes-related complications
METHODS: A cross-sectional design, analyzing pooled data from the 2018-2022 Medical Expenditure Panel Survey. Adults aged ≥18 years who reported a diagnosis of diabetes were included. The primary outcome was receipt of all five recommended diabetes preventive services (≥2 A1c tests, eye examination, foot examination, cholesterol check, and influenza vaccination). Survey-weighted descriptive analyses estimated prevalence, and complex samples logistic regression was employed to assess factors associated with incomplete receipt of all five services, accounting for MEPS’s multistage sampling design
RESULTS: Among adults with diabetes, only 37.7% received all five recommended preventive services Education level, race/ethnicity, insurance category, sex, and age were significant predictors of receiving all five recommended diabetes preventive services (Adjusted Wald F p < .05). Higher educational level was strongly associated with increased service utilization; individuals with a master’s degree (OR = 0.19, 95% CI: 0.05-0.71) or doctorate degree (OR = 0.21, 95% CI: 0.05-0.82) had substantially lower odds of missing services. Although the overall race/ethnicity effect was significant (p = .002), pairwise comparisons did not reach statistical significance. Females had greater odds of not receiving all services compared with males (OR = 0.84, 95% CI: 0.67-0.98). Increasing age was associated with higher service uptake (B = −0.31, p < .001)
CONCLUSIONS: Persistent disparities by education, insurance status, and race/ethnicity highlight inequities in access to high-quality diabetes care. Targeted policy and health system interventions are necessary to enhance equitable access to diabetes preventive care and mitigate avoidable diabetes-related complications
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD2
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)