Loss of independence as a metric for racial disparities in lower extremity amputation for diabetes: A National Surgery Quality Improvement Program (NSQIP) analysis

Spiera, Zachary; Ilonzo, Nicole; Kaplan, Harrison; Leitman, I. Michael

doi:10.1016/j.jdiacomp.2021.108105

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…Specifically, patients of races other than White and those with Hispanic ethnicity experienced a greater association between switching to an HDHP and the ESKD and proliferative retinopathy outcomes and a slightly lesser association with myocardial infarction. Importantly, Black individuals with diabetes are more likely to experience diabetes complications compared with White patients, including chronic kidney disease and ESKD, 38 , 39 , 40 , 41 , 42 , 43 amputation, 39 , 40 , 44 , 45 cardiovascular disease, 39 , 40 and retinopathy. 41 , 46 , 47 High-deductible health plans may further exacerbate these disparities, particularly because Black, Hispanic, and low-income HDHP enrollees are less likely to participate in HSAs, 27 which can help offset some of the cost-sharing burden for patients and result in greater susceptibility to the financial burden of HDHP enrollment.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, Black individuals with diabetes are more likely to experience diabetes complications compared with White patients, including chronic kidney disease and ESKD, [38][39][40][41][42][43] amputation, 39,40,44,45 cardiovascular disease, 39,40 and retinopathy. 41,46,47 High-deductible health plans may further exacerbate these disparities, particularly because Black, Hispanic, and low-income HDHP enrollees are less likely to participate in HSAs, 27 which can help offset some of the costsharing burden for patients and result in greater susceptibility to the financial burden of HDHP enrollment.…”

Section: Jama Network Open | Diabetes and Endocrinologymentioning

confidence: 99%

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Enrollment in High-Deductible Health Plans and Incident Diabetes Complications

McCoy,

Swarna,

Jiang

et al. 2024

JAMA Netw Open

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ImportancePreventing diabetes complications requires monitoring and control of hyperglycemia and cardiovascular risk factors. Switching to high-deductible health plans (HDHPs) has been shown to hinder aspects of diabetes care; however, the association of HDHP enrollment with microvascular and macrovascular diabetes complications is unknown.ObjectiveTo examine the association between an employer-required switch to an HDHP and incident complications of diabetes.Design, Setting, and ParticipantsThis retrospective cohort study used deidentified administrative claims data for US adults with diabetes enrolled in employer-sponsored health plans between January 1, 2010, and December 31, 2019. Data analysis was performed from May 26, 2022, to January 2, 2024.ExposuresAdults with a baseline year of non-HDHP enrollment who had to switch to an HDHP because their employer offered no non-HDHP alternative in that year were compared with adults who were continuously enrolled in a non-HDHP.Main Outcomes and MeasuresMixed-effects logistic regression models examined the association between switching to an HDHP and, individually, the odds of myocardial infarction, stroke, hospitalization for heart failure, lower-extremity complication, end-stage kidney disease, proliferative retinopathy, treatment for retinopathy, and blindness. Models were adjusted for demographics, comorbidities, and medications, with inverse propensity score weighting used to account for potential selection bias.ResultsThe study included 42 326 adults who switched to an HDHP (mean [SD] age, 52 [10] years; 19 752 [46.7%] female) and 202 729 adults who did not switch (mean [SD] age, 53 [10] years; 89 828 [44.3%] female). Those who switched to an HDHP had greater odds of experiencing all diabetes complications (odds ratio [OR], 1.11; 95% CI, 1.06-1.16 for myocardial infarction; OR, 1.15; 95% CI, 1.09-1.21 for stroke; OR, 1.35; 95% CI, 1.30-1.41 for hospitalization for heart failure; OR, 2.53; 95% CI, 2.38-2.70 for end-stage kidney disease; OR, 2.23; 95% CI, 2.17-2.29 for lower-extremity complication; OR, 1.17; 95% CI, 1.13-1.21 for proliferative retinopathy; OR, 2.35; 95% CI, 2.18-2.54 for blindness; and OR, 2.28; 95% CI, 2.15-2.41 for retinopathy treatment).Conclusions and RelevanceThis study found that an employer-driven switch to an HDHP was associated with increased odds of experiencing all diabetes complications. These findings reinforce the potential harm associated with HDHPs for people with diabetes and the importance of affordable and accessible chronic disease management, which is hindered by high out-of-pocket costs incurred by HDHPs.

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Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Diabetes and Endocrinologymentioning

confidence: 99%

Enrollment in High-Deductible Health Plans and Incident Diabetes Complications

McCoy,

Swarna,

Jiang

et al. 2024

JAMA Netw Open

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“…The literature has shown disparities in discharge determinations, and our analysis suggests that these differences may lead to tangible differences in health outcomes, hence further substantiating the need to improve discharge disposition decision making. Specifically, patients identifying as Black, living in communities scoring higher on the Community Deprivation Index, and those of lower socioeconomic status are more commonly placed in non-home destinations [21,42,43]. Similarly, high-volume hospitals, which have been shown to have better outcomes, were two times more likely to discharge patients to home.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Discharge Destination Impacts 30-Day Outcomes: A National Surgical Quality Improvement Program Multi-Specialty Surgical Cohort Analysis

Riveros,

Ranganathan,

Shah

et al. 2023

JCM

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Surgical patients can be discharged to a variety of facilities which vary widely in intensity of care. Postoperative readmissions have been found to be more strongly associated with post-discharge events than pre-discharge complications, indicating the importance of discharge destination. We sought to evaluate the association between discharge destination and 30-day outcomes. A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were dichotomized based on discharge destination: home versus non-home. The main outcome of interest was 30-day unplanned readmission. The secondary outcomes included post-discharge pulmonary, infectious, thromboembolic, and bleeding complications, as well as death. In this cohort study of over 1.5 million patients undergoing common surgical procedures across eight surgical specialties, we found non-home discharge to be associated with adverse 30-day post-operative outcomes, namely, unplanned readmissions, post-discharge pulmonary, infectious, thromboembolic, and bleeding complications, as well as death. Non-home discharge is associated with worse 30-day outcomes among patients undergoing common surgical procedures. Patients and caregivers should be counseled regarding discharge destination, as non-home discharge is associated with adverse post-operative outcomes.

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