Association between the quality of primary care, insurance coverage, and diabetes-related health outcomes in a cohort of older adults in China: results from the China Health and Retirement Longitudinal Study
ObjectiveThis study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary care in a cohort of older Chinese adults.Design and settingData from the China Health and Retirement Longitudinal Study, a nationally-representa...
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| Vydáno v: | BMJ open Ročník 12; číslo 9; s. e059756 |
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| Jazyk: | angličtina |
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British Medical Journal Publishing Group
26.09.2022
BMJ Publishing Group LTD BMJ Publishing Group |
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| Abstract | ObjectiveThis study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary care in a cohort of older Chinese adults.Design and settingData from the China Health and Retirement Longitudinal Study, a nationally-representative panel survey of people aged 45 and over in China.ParticipantsAmong participants with valid diabetes-related and hypertension-related medical history and biomarkers (n=8207), participants with diabetes (n=1318) were identified using biomarkers and self-reported medical history. Individual models were run using complete case analysis.ResultsAmong 1318 individuals with diabetes in 2011, 59.8% were unaware of their disease status. Diagnosis rates were significantly higher among participants with more generous public health insurance coverage (OR 3.58; 95% CI 2.15 to 5.98) and among those with other comorbidities such as dyslipidemia (OR 2.88; 95% CI 2.03 to 4.09). After adjusting for demographics, individuals with more generous public health insurance coverage did not have better glucose control at 4 years follow-up (OR 0.55; 95% CI 0.26 to 1.18) or fewer inpatient hospital admissions at 4 years (OR 1.29; 95% CI 0.72 to 2.33) and 7 years follow-up (OR 1.12; 95% CI 0.62 to 2.05). Individuals living in counties with better county-level primary care did not have better glucose control at 4 years follow-up (OR 0.69; 95% CI 0.01 to 33.36), although they did have fewer inpatient hospital admissions at 4 years follow-up (OR 0.03; 95% CI 0.00 to 0.95). Diabetes diagnosis was a significant independent predictor of both better glucose control at 4 years follow-up (OR 13.33; 95% CI 8.56 to 20.77) and increased inpatient hospital stays at 4 years (OR 1.72; 95% CI 1.20 to 2.47) and 7 years (OR 1.82; 95% CI 1.28 to 2.58) follow-up.ConclusionsThese findings suggest that participants with diabetes are often diagnosed concurrently with other comorbid disease conditions or after diabetes-related complications have already developed, thus leading to worse health outcomes in subsequent years despite improvements in health associated with better primary care. These findings suggest the importance of strengthening primary care and insurance coverage among older adults to focus on diagnosing and treating diabetes early, in order to prevent avoidable health complications and promote healthy aging. |
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| AbstractList | ObjectiveThis study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary care in a cohort of older Chinese adults.Design and settingData from the China Health and Retirement Longitudinal Study, a nationally-representative panel survey of people aged 45 and over in China.ParticipantsAmong participants with valid diabetes-related and hypertension-related medical history and biomarkers (n=8207), participants with diabetes (n=1318) were identified using biomarkers and self-reported medical history. Individual models were run using complete case analysis.ResultsAmong 1318 individuals with diabetes in 2011, 59.8% were unaware of their disease status. Diagnosis rates were significantly higher among participants with more generous public health insurance coverage (OR 3.58; 95% CI 2.15 to 5.98) and among those with other comorbidities such as dyslipidemia (OR 2.88; 95% CI 2.03 to 4.09). After adjusting for demographics, individuals with more generous public health insurance coverage did not have better glucose control at 4 years follow-up (OR 0.55; 95% CI 0.26 to 1.18) or fewer inpatient hospital admissions at 4 years (OR 1.29; 95% CI 0.72 to 2.33) and 7 years follow-up (OR 1.12; 95% CI 0.62 to 2.05). Individuals living in counties with better county-level primary care did not have better glucose control at 4 years follow-up (OR 0.69; 95% CI 0.01 to 33.36), although they did have fewer inpatient hospital admissions at 4 years follow-up (OR 0.03; 95% CI 0.00 to 0.95). Diabetes diagnosis was a significant independent predictor of both better glucose control at 4 years follow-up (OR 13.33; 95% CI 8.56 to 20.77) and increased inpatient hospital stays at 4 years (OR 1.72; 95% CI 1.20 to 2.47) and 7 years (OR 1.82; 95% CI 1.28 to 2.58) follow-up.ConclusionsThese findings suggest that participants with diabetes are often diagnosed concurrently with other comorbid disease conditions or after diabetes-related complications have already developed, thus leading to worse health outcomes in subsequent years despite improvements in health associated with better primary care. These findings suggest the importance of strengthening primary care and insurance coverage among older adults to focus on diagnosing and treating diabetes early, in order to prevent avoidable health complications and promote healthy aging. Objective This study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary care in a cohort of older Chinese adults.Design and setting Data from the China Health and Retirement Longitudinal Study, a nationally-representative panel survey of people aged 45 and over in China.Participants Among participants with valid diabetes-related and hypertension-related medical history and biomarkers (n=8207), participants with diabetes (n=1318) were identified using biomarkers and self-reported medical history. Individual models were run using complete case analysis.Results Among 1318 individuals with diabetes in 2011, 59.8% were unaware of their disease status. Diagnosis rates were significantly higher among participants with more generous public health insurance coverage (OR 3.58; 95% CI 2.15 to 5.98) and among those with other comorbidities such as dyslipidemia (OR 2.88; 95% CI 2.03 to 4.09). After adjusting for demographics, individuals with more generous public health insurance coverage did not have better glucose control at 4 years follow-up (OR 0.55; 95% CI 0.26 to 1.18) or fewer inpatient hospital admissions at 4 years (OR 1.29; 95% CI 0.72 to 2.33) and 7 years follow-up (OR 1.12; 95% CI 0.62 to 2.05). Individuals living in counties with better county-level primary care did not have better glucose control at 4 years follow-up (OR 0.69; 95% CI 0.01 to 33.36), although they did have fewer inpatient hospital admissions at 4 years follow-up (OR 0.03; 95% CI 0.00 to 0.95). Diabetes diagnosis was a significant independent predictor of both better glucose control at 4 years follow-up (OR 13.33; 95% CI 8.56 to 20.77) and increased inpatient hospital stays at 4 years (OR 1.72; 95% CI 1.20 to 2.47) and 7 years (OR 1.82; 95% CI 1.28 to 2.58) follow-up.Conclusions These findings suggest that participants with diabetes are often diagnosed concurrently with other comorbid disease conditions or after diabetes-related complications have already developed, thus leading to worse health outcomes in subsequent years despite improvements in health associated with better primary care. These findings suggest the importance of strengthening primary care and insurance coverage among older adults to focus on diagnosing and treating diabetes early, in order to prevent avoidable health complications and promote healthy aging. This study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary care in a cohort of older Chinese adults.OBJECTIVEThis study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary care in a cohort of older Chinese adults.Data from the China Health and Retirement Longitudinal Study, a nationally-representative panel survey of people aged 45 and over in China.DESIGN AND SETTINGData from the China Health and Retirement Longitudinal Study, a nationally-representative panel survey of people aged 45 and over in China.Among participants with valid diabetes-related and hypertension-related medical history and biomarkers (n=8207), participants with diabetes (n=1318) were identified using biomarkers and self-reported medical history. Individual models were run using complete case analysis.PARTICIPANTSAmong participants with valid diabetes-related and hypertension-related medical history and biomarkers (n=8207), participants with diabetes (n=1318) were identified using biomarkers and self-reported medical history. Individual models were run using complete case analysis.Among 1318 individuals with diabetes in 2011, 59.8% were unaware of their disease status. Diagnosis rates were significantly higher among participants with more generous public health insurance coverage (OR 3.58; 95% CI 2.15 to 5.98) and among those with other comorbidities such as dyslipidemia (OR 2.88; 95% CI 2.03 to 4.09). After adjusting for demographics, individuals with more generous public health insurance coverage did not have better glucose control at 4 years follow-up (OR 0.55; 95% CI 0.26 to 1.18) or fewer inpatient hospital admissions at 4 years (OR 1.29; 95% CI 0.72 to 2.33) and 7 years follow-up (OR 1.12; 95% CI 0.62 to 2.05). Individuals living in counties with better county-level primary care did not have better glucose control at 4 years follow-up (OR 0.69; 95% CI 0.01 to 33.36), although they did have fewer inpatient hospital admissions at 4 years follow-up (OR 0.03; 95% CI 0.00 to 0.95). Diabetes diagnosis was a significant independent predictor of both better glucose control at 4 years follow-up (OR 13.33; 95% CI 8.56 to 20.77) and increased inpatient hospital stays at 4 years (OR 1.72; 95% CI 1.20 to 2.47) and 7 years (OR 1.82; 95% CI 1.28 to 2.58) follow-up.RESULTSAmong 1318 individuals with diabetes in 2011, 59.8% were unaware of their disease status. Diagnosis rates were significantly higher among participants with more generous public health insurance coverage (OR 3.58; 95% CI 2.15 to 5.98) and among those with other comorbidities such as dyslipidemia (OR 2.88; 95% CI 2.03 to 4.09). After adjusting for demographics, individuals with more generous public health insurance coverage did not have better glucose control at 4 years follow-up (OR 0.55; 95% CI 0.26 to 1.18) or fewer inpatient hospital admissions at 4 years (OR 1.29; 95% CI 0.72 to 2.33) and 7 years follow-up (OR 1.12; 95% CI 0.62 to 2.05). Individuals living in counties with better county-level primary care did not have better glucose control at 4 years follow-up (OR 0.69; 95% CI 0.01 to 33.36), although they did have fewer inpatient hospital admissions at 4 years follow-up (OR 0.03; 95% CI 0.00 to 0.95). Diabetes diagnosis was a significant independent predictor of both better glucose control at 4 years follow-up (OR 13.33; 95% CI 8.56 to 20.77) and increased inpatient hospital stays at 4 years (OR 1.72; 95% CI 1.20 to 2.47) and 7 years (OR 1.82; 95% CI 1.28 to 2.58) follow-up.These findings suggest that participants with diabetes are often diagnosed concurrently with other comorbid disease conditions or after diabetes-related complications have already developed, thus leading to worse health outcomes in subsequent years despite improvements in health associated with better primary care. These findings suggest the importance of strengthening primary care and insurance coverage among older adults to focus on diagnosing and treating diabetes early, in order to prevent avoidable health complications and promote healthy aging.CONCLUSIONSThese findings suggest that participants with diabetes are often diagnosed concurrently with other comorbid disease conditions or after diabetes-related complications have already developed, thus leading to worse health outcomes in subsequent years despite improvements in health associated with better primary care. These findings suggest the importance of strengthening primary care and insurance coverage among older adults to focus on diagnosing and treating diabetes early, in order to prevent avoidable health complications and promote healthy aging. |
| Author | Zhang, Adary Quan, Jianchao Eggleston, Karen |
| AuthorAffiliation | 3 Shorenstein Asia-Pacific Research Center , Stanford University , Stanford , California , USA 1 School of Medicine , Stanford University , Stanford , California , USA 2 School of Public Health , University of Hong Kong , Hong Kong , China |
| AuthorAffiliation_xml | – name: 1 School of Medicine , Stanford University , Stanford , California , USA – name: 2 School of Public Health , University of Hong Kong , Hong Kong , China – name: 3 Shorenstein Asia-Pacific Research Center , Stanford University , Stanford , California , USA |
| Author_xml | – sequence: 1 givenname: Adary orcidid: 0000-0002-4035-3148 surname: Zhang fullname: Zhang, Adary email: adazhang@stanford.edu organization: School of Medicine, Stanford University, Stanford, California, USA – sequence: 2 givenname: Jianchao orcidid: 0000-0002-8386-8512 surname: Quan fullname: Quan, Jianchao organization: School of Public Health, University of Hong Kong, Hong Kong, China – sequence: 3 givenname: Karen surname: Eggleston fullname: Eggleston, Karen organization: Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, California, USA |
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| CitedBy_id | crossref_primary_10_3389_fendo_2023_1216897 crossref_primary_10_1142_S0116110525500192 crossref_primary_10_1038_s41598_024_56777_w crossref_primary_10_1186_s12931_023_02619_8 |
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| Snippet | ObjectiveThis study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary... This study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary care in a... Objective This study aims to identify the association between diabetes diagnosis, health outcomes, insurance scheme, and the quality of county-level primary... |
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| SubjectTerms | Biomarkers Diabetes general diabetes Glucose Health insurance Health Policy Hospitals Insurance coverage Longitudinal studies Older people Patient admissions Primary care Public health |
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| Title | Association between the quality of primary care, insurance coverage, and diabetes-related health outcomes in a cohort of older adults in China: results from the China Health and Retirement Longitudinal Study |
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