Dataset Information

Type 2 Diabetes and Chronic Conditions Disparities in Medicare Beneficiaries in the State of Michigan.

ABSTRACT:

Background

This study aimed to describe the prevalence of type 2 diabetes and combinations of multiple chronic conditions (MCCs) that are leading causes of death (LCD) and confirm that disparities exist between groups based on race and sex.

Materials and methods

We conducted a retrospective cohort study using 2012 Medicare claims data from beneficiaries with type 2 diabetes over the age of 65 in the state of Michigan.

Results

Female beneficiaries have type 2 diabetes and 1 or more MCCs that are LCD more often than males. Most type 2 diabetes patients have diabetes alone without MCCs, while a large proportion have at least 1 additional chronic condition that is a LCD. One in 3 patients have 3 or more chronic conditions. The most prevalent type 2 diabetes coexisting MCCs are congestive heart failure (CHF), chronic obstructive pulmonary disease and chronic kidney disease. Asian/Pacific Islanders have the highest prevalence of type 2 diabetes without MCCs, and the highest prevalence of diabetes plus CHF. While fewer black beneficiaries have diabetes alone or 1 additional MCC, the prevalence of 3 or more MCCs in blacks generally exceeds the prevalence in other races. In beneficiaries with newly diagnosed type 2 diabetes, chronic obstructive pulmonary disease and CHF are the first new chronic conditions to be diagnosed after an initial type 2 diabetes diagnosis.

Conclusions

Race and sex disparities occur in the prevalence of type 2 diabetes and MCCs that are LCD in Medicare beneficiaries in the state of Michigan.

SUBMITTER: Clements JM

PROVIDER: S-EPMC7093222 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Type 2 Diabetes and Chronic Conditions Disparities in Medicare Beneficiaries in the State of Michigan.

Clements John M JM Rosca Mariana M Cavallin Carla C Falkenhagen Shelby S Ittoop Thomas T Jung Christina K CK Mazzella Megan M Reed Joseph A JA Schluentz Megan M VanDyke Caleb C

The American journal of the medical sciences 20200123 4

<h4>Background</h4>This study aimed to describe the prevalence of type 2 diabetes and combinations of multiple chronic conditions (MCCs) that are leading causes of death (LCD) and confirm that disparities exist between groups based on race and sex.<h4>Materials and methods</h4>We conducted a retrospective cohort study using 2012 Medicare claims data from beneficiaries with type 2 diabetes over the age of 65 in the state of Michigan.<h4>Results</h4>Female beneficiaries have type 2 diabetes and 1 ...[more]

PMID: 32087942

Similar Datasets

Project description:BackgroundHeatwaves kill more people than floods, tornadoes, and earthquakes combined and disproportionally affect older persons and those with chronic conditions. Commonly used medications for chronic conditions, e.g., diuretics, antipsychotics disrupt thermoregulation or fluid/electrolyte balance and may sensitive patients to heat. However, the effect of heat-sensitizing medications and their interactions with heatwaves are not well-quantified. We evaluated effects of potentially heat-sensitizing medications in vulnerable older patients.MethodsUS Medicare data were linked at the zip code level to climate data with surface air temperatures for June-August of 2007-2012. Patients were Medicare beneficiaries aged ≥65 years with chronic conditions including diabetes, dementia, and cardiovascular, lung, or kidney disease. Exposures were potentially heat-sensitizing medications including diuretics, anticholinergics, antipsychotics, beta blockers, stimulants, and anti-hypertensives. A heatwave was defined as ≥2 days above the 95th percentile of historical zip code-specific surface air temperatures. We estimated associations of heat-sensitizing medications and heatwaves with heat-related hospitalization using self-controlled case series analysis.ResultsWe identified 9,721 patients with at least one chronic condition and heat-related hospitalization; 42.1% of these patients experienced a heatwave. Heatwaves were associated with an increase in heat-related hospitalizations ranging from 21% (95% CI: 7% to 38%) to 33% (95% CI: 14% to 55%) across medication classes. Several drug classes were associated with moderately elevated risk of heat-related hospitalization in the absence of heatwaves, with rate ratios ranging from 1.16 (95% CI: 1.00 to 1.35) to 1.37 (95% CI: 1.14 to 1.66). We did not observe meaningful synergistic interactions between heatwaves and medications.ConclusionsOlder patients with chronic conditions may be at heightened risk for heat-related hospitalization due to the use of heat-sensitizing medications throughout the summer months, even in the absence of heatwaves. Further studies are needed to confirm these findings and also to understand the effect of milder and shorter heat exposure.

Project description:BackgroundApproximately 28% of adults have ≥3 chronic conditions (CCs), accounting for two-thirds of U.S. healthcare costs, and often having suboptimal outcomes. Despite Institute of Medicine recommendations in 2001 to integrate guidelines for multiple CCs, progress is minimal. The vast number of unique combinations of CCs may limit progress.Methods and findingsTo determine whether major CCs segregate differentially in limited groups, electronic health record and Medicare paid claims data were examined in one accountable care organization with 44,645 Medicare beneficiaries continuously enrolled throughout 2015. CCs predicting clinical outcomes were obtained from diagnostic codes. Agglomerative hierarchical clustering defined 13 groups having similar within group patterns of CCs and named for the most common CC. Two groups, congestive heart failure (CHF) and kidney disease (CKD), included 23% of beneficiaries with a very high CC burden (10.5 and 8.1 CCs/beneficiary, respectively). Five groups with 54% of beneficiaries had a high CC burden ranging from 7.1 to 5.9 (descending order: neurological, diabetes, cancer, cardiovascular, chronic pulmonary). Six groups with 23% of beneficiaries had an intermediate-low CC burden ranging from 4.7 to 0.4 (behavioral health, obesity, osteoarthritis, hypertension, hyperlipidemia, 'other'). Hypertension and hyperlipidemia were common across groups, whereas 80% of CHF segregated to the CHF group, 85% of CKD to CKD and CHF groups, 82% of cancer to Cancer, CHF, and CKD groups, and 85% of neurological disorders to Neuro, CHF, and CKD groups. Behavioral health diagnoses were common only in groups with a high CC burden. The number of CCs/beneficiary explained 36% of the variance (R2 = 0.36) in claims paid/beneficiary.ConclusionsIdentifying a limited number of groups with high burdens of CCs that disproportionately drive costs may help inform a practical number of integrated guidelines and resources required for comprehensive management. Cluster informed guideline integration may improve care quality and outcomes, while reducing costs.

Dataset Information

Type 2 Diabetes and Chronic Conditions Disparities in Medicare Beneficiaries in the State of Michigan.

Background

Materials and methods

Results

Conclusions

Publications

Type 2 Diabetes and Chronic Conditions Disparities in Medicare Beneficiaries in the State of Michigan.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets