Differences in receipt of recommended eye examinations by comorbidity status and healthcare utilization among nonelderly adults with diabetes. Issue 11 (26th October 2022) - Cai, Cindy X.
Abstract: Background: To evaluate the effect of diabetes comorbidities by baseline healthcare utilization on receipt of recommended eye examinations. Methods: Retrospective analysis of 310 691 nonelderly adults with type 2 diabetes in the IBM MarketScan Commercial Database from 2016 to 2019. Patients were grouped based on diabetes‐concordant (related) or ‐discordant (unrelated) comorbidities. Logistic regression was used to estimate the prevalence ratio (PR) for eye examinations by comorbidity status, healthcare utilization, and an interaction between comorbidities and utilization, controlling for age, sex, region, and major eye disease. Results: Prevalence of biennial eye examinations varied by the four comorbidity groups: 43.5% (diabetes only), 52.7% (concordant + discordant comorbidities), 48.0% (concordant comorbidities only), and 45.3% (discordant comorbidities only). In the lowest healthcare utilization tertile, the concordant‐only and concordant + discordant groups had lower prevalence of examinations compared to diabetes only (PR 0.95 [95% CI 0.92–0.98] and PR 0.91 [95% CI 0.88–0.95], respectively). In the medium utilization tertile, the discordant‐only and concordant + discordant groups had lower prevalence of examinations (PR 0.89 [0.83–0.95] and PR 0.94 [0.90–0.98], respectively). In the highest utilization tertile, the concordant‐only and concordant + discordant groups had higher prevalence of examinations. Conclusions: Among patients with low healthcare utilization, having comorbid conditions is associated with lower prevalence of eye examinations. Among those with medium healthcare utilization, patients with diabetes‐discordant comorbidities are particularly vulnerable. This study highlights populations of diabetes patients who would benefit from increased assistance in receiving vision‐preserving eye examinations. Abstract : Highlights Patients with diabetes who have comorbid medical conditions and are infrequent healthcare utilizers are at increased risk for not receiving recommended eye examinations. 摘要: 背景: 通过基础医疗利用评估糖尿病合并症对接受推荐眼科检查的影响。 方法: 对IBM® MarketScan® 商业数据库2016‐2019年的310691例非老年2型糖尿病患者进行回顾性分析。根据糖尿病相关或无关合并症对患者进行分组。在控制年龄, 性别, 地区和主要眼病的情况下，采用Logistic回归方法估计眼科检查的患病率(PR)，通过合并症状况, 医疗保健利用度, 以及合并症和利用度之间的相互作用来评估。 结果: 两年一次的眼科检查的患病率在四个合并症组中有所不同:43.5%(单纯糖尿病组), 52.7%(相关和无关合并症并存组), 48.0%(仅相关合并症组)和45.3%(仅无关合并症组)。在卫生保健利用率最低三分位数中，仅相关组和并存组的检查率低于仅糖尿病组(PR分别为0.95[95%CI 0.92~0.98]和PR 0.91[0.88~0.95])。在中等利用率组中，仅无关组和并存组的检查率较低(PR分别为0.89[0.83~0.95]和0.94[0.90~0.98])。在利用率最高的三分位数中，仅相关组和并存组的检查患病率较高。 结论: 在医疗保健利用率低的患者中，合并疾病与较低的眼科检查患病率相关。在那些医疗保健利用率中等的人中，患有无关共病的糖尿病患者特别容易受到伤害。这项研究强调了糖尿病患者人群将受益于接受保护视力的眼科检查