Abstract
Purpose: Limited healthcare access can affect general health for diabetics, but information on this relationship is lacking for middle-aged, female diabetics. Our study aims to assess whether general health differs by healthcare access, both coverage and cost, in diabetic females ages 30-50 years. Methods: This cross-sectional analysis used 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS) for diabetic females ages 30-50 from Louisiana, Mississippi, Oklahoma, South Carolina, and Tennessee. We assessed the relationship between general health and healthcare access, both coverage and cost, using multiple logistic regression analysis while controlling for weight status, comorbid health conditions, age, ethnicity, marital status, income, education level, and state. Results: Across states, the majority of diabetic females reported good or better general health (49-63%), having healthcare coverage (77-89%), and not having cost preclude doctor visits (69-76%). Adjusted analyses indicated that healthcare coverage was not related to general health, but those with healthcare costs precluding doctors’ visits were about two times less likely to report good or better general health. General health was also related inversely to having two or more comorbid health conditions, and related positively to income and education levels. Conclusion: General health was related inversely to healthcare costs and number of comorbid health conditions, and positively related to socioeconomic status. Given that healthcare coverage was not related to general health, the issues around health in middle-aged diabetic females may be more related to the out of pocket expenses for healthcare rather than just having health insurance. For middle-aged diabetic females in primary care, practitioners should screen for multiple health conditions and assess management for all health conditions, especially as related to whether the patient can afford treatment. Practitioners in low income areas should be aware of treatment options for those who cannot afford them.
Highlights
Diabetes is one of the fastest growing epidemics worldwide [1]
Given that healthcare coverage was not related to general health, the issues around health in middle-aged diabetic females may be more related to the out of pocket expenses for healthcare rather than just having health insurance
For middle-aged diabetic females in primary care, practitioners should screen for multiple health conditions and assess management for all health conditions, especially as related to whether the patient can afford treatment
Summary
Diabetes is one of the fastest growing epidemics worldwide [1]. In 2013, there were 382 million people living with diabetes, with the cost of diabetes management reaching $116 billion in the United States [2]. Complications increase the cost of diabetes management, with hospitalizations being the most important direct driver of cost [2]. Healthcare access is important for the identification and management of diabetes [1]; approximately 25% of adults in the United States report being uninsured for at least part of the past 12 months [4]. Access to healthcare would make required medical care more attainable; even in countries with universal health insurance coverage, not every patient utilizes the medical care available [6]. The avoidance of complications and negative outcomes related to diabetes requires access to comprehensive and integrated care [7,8], including medication access [9]
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