Date on Master's Thesis/Doctoral Dissertation

12-2024

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Cooperating University

University of Louisville

Department

Health Management and Systems Sciences

Degree Program

Public Health Sciences with a specialization in Health Management, PhD

Committee Chair

Little, Bert

Committee Co-Chair (if applicable)

Karimi, Seyed

Committee Member

Karimi, Seyed

Committee Member

Fu, Wei

Committee Member

Roelfs, David

Author's Keywords

access; heath care; diabetes; NHANES

Abstract

Background and Purpose: Diabetes mellitus is a chronic metabolic condition associated with numerous medical and financial sequences. In 2018, 34.1 million adults aged 18 years or older had diabetes in the U.S. Access to Care for diabetic Americans remains a public healthcare concern. This study aims to examine the relationship between access to healthcare and selected diabetes indicators. Methods: A quantitative, repeated cross-sectional study uses four of the National Health and Nutrition Examinations Survey's (NHANES) access measures (insurance, the number of times of annual healthcare visits, routine place for healthcare, and type of place) and four diabetes indicators (Hemoglobin A1C (HbA1C), systolic and diastolic blood pressure (SBP, DBP), and LD-cholesterol) to examine the relationship between access to health care and diabetes indicators among diabetic U.S. adults aged 18 years and above in the NHANES 2005-2018 datasets. Results: Our cohorts, in total, included 5,247 participants who met our inclusion and exclusion criteria. Results revealed that uninsured individuals displayed significantly lower odds of having high HbA1C levels, with an OR of 0.54 (95% CI: 0.42, 0.70), compared to those insured (OR = 1). Participants who had 4-5 visits benefited from a lower risk, evidenced by an OR of 0.75 (95% CI: 0.62, 0.90). Those without a routine care provider were less likely to exhibit high SBP (OR = 0.65, 95% CI 0.36, 1.17) than their counterparts with a consistent provider (OR = 1). However, individuals who sought care at an ED or ED OPD had a notable increase in their odds of high SBP, shown by an OR of 1.25 (95% CI: 0.82, 1.90), compared to those using OPD or HMO services (OR = 1). Our research underscores a significant link between the lack of health insurance and inadequate care among individuals living with diabetes. Alarmingly, our findings show that uninsured individuals are considerably more likely to suffer from uncontrolled diabetes, which can lead to severe complications, including cardiovascular disease, kidney failure, and vision impairment. These insights are crucial for policymakers, highlighting an urgent need for targeted interventions to improve healthcare access for this vulnerable population. By addressing the barriers that prevent uninsured diabetics from receiving necessary care, policymakers can adopt effective strategies such as expanding Medicaid eligibility, strengthening community health programs, and increasing funding for comprehensive diabetes education initiatives. These measures not only hold the potential to decrease the prevalence of uncontrolled diabetes but also to alleviate the extensive economic and social burdens associated with diabetes complications. The prospect of such positive changes inspires hope and optimism, paving the way for improved health outcomes and reduced healthcare costs throughout the nation. The implications of our research serve as a compelling call to action, urging decision-makers to prioritize equitable healthcare access as a fundamental aspect of diabetes management and prevention strategies. Ensuring that all individuals, regardless of their insurance status, receive the quality care they need is essential for effective diabetes management.

Download

Share

COinS