Between Individuals with and Without Diabetes

Table 1 compares African-American patients with and without diabetes in this sample. The two groups did not differ significantly on age, gender, or TennCare (Medicaid) enrollment. However, group differences in income and education were observed, with lower levels of income and lower rates of high-school graduation among individuals with diabetes (p<0.05). Further, diabetic patients (86.4%) were more likely to have another chronic medical condition (hypertension and/or cardiovascular disease) compared to nondiabetic patients (73.5%, p<0.05). Nevertheless, African-American patients with and without diabetes did not differ significantly in their mean levels of reported physician visits (3.5 and 3.2), ER visits (both 0.7), or inpatient days (2.2. and 1.7).

Diabetes and Depressive Symptoms

In this sample of African-American primary care patients, diabetes was not significantly associated with depressive symptoms (Table 2). First, diabetic patients had only a slightly greater number and/or frequency of depressive symptoms compared to non-diabetic patients, with mean CES-D scores of 9.4 and 8.4, respectively. Second, only a slightly higher percentage of patients with diabetes exhibited elevated depressive symptoms or major depressive symptoms compared to those without diabetes (21.6% versus 15%withCESD>16; 17.2% versus 13.0% classified as “depressed” based on PRIME-MD criteria). These differences remained insignificant even when controlling for age, gender, SES, and comorbid chronic conditions (results not shown).

Table 2. Level of Depressive Symptoms Among African-American Primary Care Patients with and Without Diabetes (Meharry Medical Practice Plan, Nashville, TN; 2001)

No Diabetes Diabetes P
Mean CES-D score                                                    8.4 Percent elevated symptoms (CES-D 16+)                       15.0 Percent major depressive symptoms (PRIME-MD criteria)    13.0 9.4 21.6 17.2 0.441 0.167 0.342

Diabetes, Depression, and Healthcare Utilization

Table 3 reports Poisson regression estimates of the additive effects of diabetes and major depressive symptoms (“depressed” by PRIME-MD criteria), as well as the interactive effect of co-occurring diabetes and depression, on each of the three health service utilization outcomes. These results are from the sample of African-American patients age 40 and over, and models control for demographic variables and comorbid chronic conditions. The presence of diabetes only (without depression) had a marginal but insignificant effect on the number of physician visits and ER visits but was significantly associated with lower inpatient days (B= -0.231, Exp(B)=0.79, p<0.05). In other words, nondepressed diabetics patients reported 21% lower inpatient days than patients with neither diabetes nor depression, controlling for other factors. The presence of depressive symptoms only (without diabetes) was significantly associated with a greater number of physician visits (B=0.567, Exp(B)=1.76, p<0.01) but was not associated with a higher number of ER visits or inpatient days. In other words, nondiabetic depressed patients reported 76% greater number of physician visits than patients with neither diabetes nor depression. buy antibiotics canada

Table 3. Poisson Regression Estimates of the Effect of Diabetes and PRIME-MD Major Depressive Symptoms on Healthcare Utilization Outcomes Among African-American Patients, n=298 (Meharry Medical Practice Plan, Nashville, TN; 2001)

Physician Visits В            Exp(B) ER Visits В            Exp(B) Inpatient Days В           Exp(B)

Age

-0.006

0.99*

-0.029

0.97**

0.007

1.01 +

Female

-0.046

0.96

-0.200

0.82

-0.603

0.55**

SES

0.098

1.10**

-0.326

0.72**

-0.248

0.78**

Other chronic

0.430

1.54**

0.083

1.09

1.355

3.88**

Diabetes

0.149

1.16+

-0.354

0.70+

-0.231

0.79*

Depressed

0.567

1.76**

0.221

1.25

0.017

1.02

Diabetes* depressed

-0.319

0.73+

1.012

2.75**

1.104

3.02**

Constant

1.115

3.05

1.307

3.70

-0.729

0.48

Levels of significance:

+p<0.10; *p<0.05;

**p<0.01

The concurrent presence of diabetes and major depressive symptoms (the interaction of diabetes • depression) had a marginal but insignificant effect on physician visits but was significantly associated with a higher number of ER visits (B=1.012, Exp(B)=2.75, p<0.01) and with greater numbers of inpatient days (B=1.104, Exp(B)=3.02, p<0.01). In other words, depressed diabetics reported 2.75 times (or nearly three times) more ER visits than patients with neither diabetes nor depression. Further, depressed diabetics reported three times more inpatient days than patients with neither diabetes nor depression. Notably, the presence of other chronic conditions (hypertension and/or cardiovascular disease) also impacted utilization, but in a different way than diabetes and depression. African-American patients with these chronic conditions visited the doctor more and had more inpatients days than patients without these chronic conditions, but they did not differ in terms of numbers of ER visits. Specifically, African-American patients with hypertension and/or cardiovascular disease had 54% greater number of physician visits (B=0.430, Exp(B)=1.54, p<0.01) and nearly four times the number of inpatient days (B=1.355, Exp(B)=3.88, p<0.01) than African-American patients without these conditions, while controlling for the presence of diabetes, major depressive symptoms, and demographic factors.

Category: Diabetes / Tags: African Americans, Depression, Diabetes, primary care, service utilization

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