Sex Differences in Diabetes Prevalence, Comorbidities, and Health Care Utilization among American Indians Living in the Northern Plains.

Joan O’Connell,Valarie Blue Bird Jernigan,Jennifer Rockell,Spero M Manson,Charlton Wilson,Kimberly R Huyser,Tori Taniguchi

doi:10.1093/cdn/nzz089

Abstract

ABSTRACTBackgroundThe American Indian (AI) population experiences significant diet-related health disparities including diabetes and cardiovascular disease (CVD). Owing to the relatively small sample size of AIs, the population is rarely included in large national surveys such as the NHANES. This exclusion hinders efforts to characterize potentially important differences between AI men and women, track the costs of these disparities, and effectively treat and prevent these conditions.ObjectiveWe examined the sex differences in diabetes prevalence, comorbidity experience, health care utilization, and treatment costs among AIs within a Northern Plains Indian Health Service (IHS) service unit.MethodsWe assessed data from a sample of 11,144 persons using an IHS service unit in the Northern Plains region of the United States. Detailed analyses were conducted for adults (n = 7299) on prevalence of diabetes by age and sex. We described sex differences in comorbidities, health care utilization, and treatment costs among the adults with diabetes.ResultsIn our sample, adult men and women had a similar prevalence of diabetes (10.0% and 11.0%, respectively). The prevalence of CVD among men and women with diabetes was 45.7% and 34.0%, respectively. Among adults with diabetes, men had a statistically higher prevalence of hypertension and substance use disorders than women. The men were statistically less likely to have a non–substance use mental health disorder. Although men had higher utilization and costs for hospital inpatient services than women, the differences were not statistically significant.ConclusionsIn this AI population, there were differences in comorbidity profiles between adult men and women with diabetes, which have differential mortality and cost consequences. Appropriate diabetes management addressing gender-specific comorbidities, such as substance use disorders for men and non–substance use mental health disorders for women, may help reduce additional comorbidities or complications to diabetes.

Highlights

American Indian and Alaska Native peoples (AI/ANs) are more than twice as likely to experience diet-related health disparities [e.g., diabetes, obesity, or cardiovascular disease (CVD)] as the general US population [1, 2]
In our sample, adult men and women had a similar prevalence of diabetes (10.0% and 11.0%, respectively)
From 1990 to 2009, AI men had a higher diabetes-related mortality rate than AI women [14]. These sex difference trends extend to health care service use where females with diabetes use more health care services than males with diabetes [15]. To contribute to this understanding, we examine the sex differences in diabetes prevalence, comorbidity experience, health care utilization, and treatment costs within a Northern Plains Indian Health Service (IHS) service area—the IHS is an agency within the Department of Health and Human Services and the principal federal health care provider for AI/ANs [16,17,18]

Summary

Introduction

American Indian and Alaska Native peoples (AI/ANs) are more than twice as likely to experience diet-related health disparities [e.g., diabetes, obesity, or cardiovascular disease (CVD)] as the general US population [1, 2]. The American Indian (AI) population experiences significant diet-related health disparities including diabetes and cardiovascular disease (CVD). Owing to the relatively small sample size of AIs, the population is rarely included in large national surveys such as the NHANES. This exclusion hinders efforts to characterize potentially important differences between AI men and women, track the costs of these disparities, and effectively treat and prevent these conditions

Methods

Results

Discussion

Conclusion