Disparities in Diabetes Care: Differences Between Rural and Urban Patients Within a Large Health System
Newswise — Researchers from Mayo Clinic conducted an analysis within their healthcare system to uncover factors linked to the quality of care in both rural and urban patients suffering from diabetes. The investigation assessed patients' achievement of a five-part standard for diabetes care called the D5 metric. This metric encompasses the absence of tobacco usage, maintaining hemoglobin A1C levels below 8%, maintaining blood pressure levels below 140/90, utilization of statins, and usage of aspirin. The study took into account variables such as age, gender, race, Adjusted Clinical Group score (a set of distinct health status categories based on morbidity, age, and gender), type of insurance, type of primary care clinician, and healthcare utilization data.
Data from 45,279 individuals with diabetes under the care of primary care providers were examined by the researchers. Among these patients, 54.4% resided in rural areas. Of the rural patients, 39.9% met all five criteria of the D5 metric, whereas 43.2% of urban patients achieved the same (P<0.001). The likelihood of rural patients meeting all metric goals was significantly lower compared to urban patients (adjusted odds ratio 0.93 [95% confidence interval 0.88-0.97]). Additionally, rural patients had a lower average number of outpatient visits (3.2 visits) in contrast to urban patients (3.9 visits, P<.0001). Furthermore, rural patients had fewer visits to endocrinologists, with only 5.5% attending such appointments, whereas 9.3% of urban patients did (P<.0001).
During the study period, it was observed that patients who had an endocrinology visit were less likely to achieve the metric goals, with an adjusted odds ratio of 0.80 (95% confidence interval 0.73-0.86). This finding may be attributed to the fact that individuals with more severe illness are typically referred to endocrinologists. On the other hand, there was a positive association between the number of outpatient visits and the attainment of metric goals, with an odds ratio of 1.03 (95% confidence interval 1.03-1.04). This suggests that a higher frequency of outpatient visits is correlated with a higher likelihood of meeting the metric goals.
After considering various contributing factors and accounting for them in the analysis, the researchers reached the conclusion that rural patients experienced poorer quality outcomes in managing their diabetes compared to urban patients, despite both groups being part of the same integrated health system. The study team speculated that the lower frequency of visits and limited access to specialty care in rural areas could be potential factors contributing to this disparity. In other words, the reduced visit frequency and lack of specialized medical attention in rural settings might play a role in the observed differences in diabetic quality outcomes between rural and urban patients.
What We Know: Current knowledge indicates that Type 2 diabetes poses a significant health challenge in the United States, affecting approximately 11% of the population. Researchers emphasize the importance of gaining a deeper understanding of the multifaceted factors that contribute to the effective management of diabetes and its associated conditions. Among the various social determinants of health that influence diabetes, rurality stands out as a significant factor associated with an increased likelihood of diabetes diagnosis.
What This Study Adds: This study contributes by highlighting that rural patients experience inferior diabetic quality metrics compared to their urban counterparts, even when considering factors such as belonging to the same integrated health system and variations in healthcare providers and clinic settings. The researchers found that visit frequency and the involvement of specialty doctors might play a role in these disparities, although the study accounted for these differences at the patient level. The authors of the study argue that broader interventions are necessary to enhance the quality of care provided by doctors to patients with diabetes residing in rural areas.
Disparities in Diabetes Care: Differences Between Rural and Urban Patients Within a Large Health System. Randy Foss, MD, et al, Department of Family Medicine, Mayo Clinic Health System, Lake City, Minnesota
RSS