The impact of hypothyroidism on cardiovascular-related healthcare utilization in the US population with diabetes

Abstract

Structured Abstract Context Suboptimal treatment of hypothyroidism (HT) is associated with adverse cardiovascular disease (CVD) outcomes, for which patients with diabetes mellitus (DM) are at increased risk. Objective This study aimed to compare CVD-related healthcare utilization in DM patients with and without HT in the US population. Methods Participant data was collected from the Medical Expenditure Panel Survey (MEPS) over 10 years (2011–2020). Medical conditions were identified by ICD-9/ICD-10 codes associated with expenditures. Healthcare utilization outcomes included number of emergency, hospital, and outpatient visits associated with coronary artery disease (CAD), stroke/transient ischemic attack (TIA), or heart failure (HF), prescriptions related to CVD, and number of visits to specialty providers. A propensity score-based fine stratification matching approach was used to balance sociodemographic covariates to determine the relative risk (RR) contributed by HT on CVD-related care utilization. Results A total of 15,580 adult participants with DM were identified, of which 11.9% had treated HT. In the weighted analysis, a significantly greater proportion of participants with HT had CAD and stroke/TIA-associated visits compared to those without HT (22.4% vs. 17.8%, p: 0.002; and 7.3% vs. 5.4%, p: 0.020). In the matched analysis, participants with HT were more likely to see a specialist (cardiology, endocrinology, and nephrology). Participants with HT were more likely to be treated with cholesterol-lowering medications, beta-blockers, and diuretics. Conclusions HT as a comorbidity with DM was associated with increased healthcare utilization related to CVD, specifically visits associated with stroke/TIA, increased use of specialty care, and greater utilization of CVD-related medications.