Date of Award
1-1-2023
Document Type
Thesis
Degree Name
M.S. in Pharmaceutical Science
First Advisor
Marie Barnard
Second Advisor
John Bentley
Third Advisor
Kaustuv Bhattacharya
Relational Format
dissertation/thesis
Abstract
Background: More than 85% type 2 diabetes mellitus(T2DM) patients have at least one other comorbid condition. Recent data has shown an increase in cardiovascular (CVD) and mental health conditions (MHD) among diabetes patients. Because of the pathological difference in CVD and MHD, their management is unique. We may see differential utilization of healthcare services among T2DM patients with these comorbidities. The study’s aim was to estimate the prevalence of CVD and MHD among older T2DM patients and to assess the comparative healthcare utilization among T2DM patients with these comorbidities by service type.
Methodology: A retrospective cohort analysis was conducted using 5% national Medicare data from 2012 to 2018. T2DM diagnosis date was the index date. Based on their comorbidities, the patients were classified into four study cohorts: T2DM with neither CVD nor MHD; T2DM with CVD but no MHD; T2DM with MHD but no CVD; T2DM with both CVD and MHD. Healthcare utilization was measured as the number of visits by service type. In addition to descriptive statistics, generalized linear models adjusted for covariates were fit by outcome service type and incident rate ratios were reported.
Results: Of the 225165 T2DM patients, 22.42%(n=50474) had CVD but no MHD, 10.61% (n = 23887) had MHD but no CVD, and 8.01%(n=18045) had both CVD and MHD. When compared to T2DM patients with neither CVD nor MHD, those with CVD but no MHD had 24% higher inpatient visits, 20% higher outpatient visits and 22% higher ED visits. Similarly, T2DM patients with MHD but no CVD had 1.29 times as high inpatient visits, 1.34 times as high outpatient visits and 1.42 times as high ED visits as T2DM patients with neither CVD nor MHD. Additionally, when compared to T2DM patients with CVD but no MHD, those with MHD but no CVD had 4% higher inpatient visits, 11% higher outpatient visits and 16% higher ED visits.
Conclusion: Healthcare utilization differs by service type among T2DM patients with CVD and MHD comorbidities. The study results will help providers identify at-risk patients and encourage policy makers to appropriately allocate resources and develop targeted and integrated interventions.
Recommended Citation
Prajapati, Prachi, "Impact of cardiovascular and mental health comorbidities on all-cause healthcare utilization among older patients with Type 2 diabetes" (2023). Electronic Theses and Dissertations. 2766.
https://egrove.olemiss.edu/etd/2766