313-OR: Disparities in Preventive Care Utilization among Patients with Diabetes in the Diabetes Belt and Surrounding Areas

Abstract

Objective: Preventive care has been shown to reduce both the incidence and progression of diabetic complications. American Diabetes Association treatment guidelines recommend annual preventive care such as annual doctor visits and A1c tests. Our objective is to compare utilization rates of four annually recommended preventive services for persons with diabetes in the Diabetes Belt and those in the surrounding area. Methods: We used 2015 Medicare claims data to identify preventive service utilization using ICD9/10 and CPT/HCPCS codes. Diabetes Belt consists of 644 counties in the Appalachian region and southeastern part of US that had diabetes prevalence over 11% in 2008 compared to ~8.5% in the rest of the country. Surrounding counties include 118 counties that are adjacent but not contiguous to the Diabetes Belt counties. Results: Patients in the Belt had significantly lower utilization than those in surrounding counties for all four preventive services: foot exam, 81% vs. 88%; eye exam, 53% vs. 58%; microalbuminuria test, 31% vs. 34%; one or more A1c tests, 73% vs. 74%. After adjusting for age, sex, and race/ethnicity, patients in the Diabetes Belt had 38%, 18%, 16%, and 11% lower odds of using foot exams, microalbuminuria tests, eye exams, and A1c tests, respectively, compared to those in the surrounding counties (p for all comparisons < 0.001). Even after adjusting for socioeconomic, access-to-care factors, and service availability, patients in the Diabetes Belt had consistently lower rates of utilization for these four services than surrounding counties. Conclusion: Patients with diabetes in the Diabetes Belt are doubly jeopardized for diabetic complications because of higher prevalence diabetes and lower preventive care utilization than surrounding counties. Health policy makers may want to pay more attention to the Diabetes Belt in reducing the regional differences in the utilization of these services. Disclosure M. Sohn: None. H. Kang: None. T. L. Mcmurry: None. S. Kim: None. J. M. Lobo: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK113295)