Population-based study of the association between food insecurity and preventable hospitalization among persons with diabetes using linked survey and administrative data

Gupta, Neeru; Sheng, Zihao

doi:10.23889/ijpds.v4i1.1102

Cited by 5 publications

(7 citation statements)

References 27 publications

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“…In this study of 1,306 PCC patients, Black/African American race and 2 variables related to socioeconomic status, Medicaid use and prior hospital admission, [55][56][57] were independent risk factors for greater future hospitalization utilization and cost outcomes following an admission with PCC. Compared to White patients, Black/African American patients were more likely to accrue any future cost (i.e., any future hospitalization) and be readmitted within 30 days, experienced more future days hospitalized, and accrued greater future hospitalization costs.…”

Section: Discussionmentioning

confidence: 71%

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Starr

Ulrich

Pérez

et al. 2021

Am J Hosp Palliat Care

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Background: Palliative care consultation to discuss goals-of-care (“PCC”) may mitigate end-of-life care disparities. Objective: To compare hospitalization and cost outcomes by race and ethnicity among PCC patients; identify predictors of hospice discharge and post-discharge hospitalization utilization and costs. Methods: This secondary analysis of a retrospective cohort study assessed hospice discharge, do-not-resuscitate status, 30-day readmissions, days hospitalized, ICU care, any hospitalization cost, and total costs for hospitalization with PCC and hospitalization(s) post-discharge among 1,306 Black/African American, Latinx, White, and Other race PCC patients at a United States academic hospital. Results: In adjusted analyses, hospice enrollment was less likely with Medicaid (AOR = 0.59, P = 0.02). Thirty-day readmission was less likely among age 75+ (AOR = 0.43, P = 0.02); more likely with Medicaid (AOR = 2.02, P = 0.004), 30-day prior admission (AOR = 2.42, P < 0.0001), and Black/African American race (AOR = 1.57, P = 0.02). Future days hospitalized was greater with Medicaid (Coefficient = 4.49, P = 0.001), 30-day prior admission (Coefficient = 2.08, P = 0.02), and Black/African American race (Coefficient = 2.16, P = 0.01). Any future hospitalization cost was less likely among patients ages 65-74 and 75+ (AOR = 0.54, P = 0.02; AOR = 0.53, P = 0.02); more likely with Medicaid (AOR = 1.67, P = 0.01), 30-day prior admission (AOR = 1.81, P = 0.0001), and Black/African American race (AOR = 1.40, P = 0.02). Total future hospitalization costs were lower for females (Coefficient = −3616.64, P = 0.03); greater with Medicaid (Coefficient = 7388.43, P = 0.01), 30-day prior admission (Coefficient = 3868.07, P = 0.04), and Black/African American race (Coefficient = 3856.90, P = 0.04). Do-not-resuscitate documentation (48%) differed by race. Conclusions: Among PCC patients, Black/African American race and social determinants of health were risk factors for future hospitalization utilization and costs. Medicaid use predicted hospice discharge. Social support interventions are needed to reduce future hospitalization disparities.

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Section: Discussionmentioning

confidence: 71%

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Starr

Ulrich

Pérez

et al. 2021

Am J Hosp Palliat Care

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“…This study builds the evidence base on social capital among people living with diabetes by drawing on multiple years of nationally representative linked survey and administrative datasets to examine the risk of acute-care hospitalization, a statistically rare event but among the costliest categories to the healthcare system. The use of linked data offers analytical opportunities not afforded by a single source, notably the ability to account for individuals' diabetes status and their strength of belonging (since hospital records do not capture diagnoses in primary care or psychosocial variables) (16). Our results underscore the increasing emphasis of shifting the focus from acute care to supporting patients with chronic conditions through community-based interventions facilitating positive social networks, such as developing transportation networks, recreation programs and hobby groups, or cohousing communities for older adults (2,6,(32)(33)(34).…”

Section: Discussionmentioning

confidence: 99%

“…Second is the risk of measurement error; 3.9% of the CCHS respondents were missing valid data on community belonging and thus were omitted. Third, due to sample size constraints (N = 180 acute-care admissions over the period of observation), we were not able to cover the full array of potential medical and non-medical predictors of adverse diabetes-related outcomes and hospitalization risks, such as adherence to self-management practices, presence and types of comorbid conditions, having a regular primary care practitioner, food insecurity, disability status, or living alone (6,12,16,20,24,35). Fourth is the risk of reverse causality; it is possible that some respondents may have perceived and reported a weakening of social ties following prolonged or repeated hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

“…In Canada, diabetes prevalence stood at 7.8% (males: 9.0%; females: 6.7%) in 2019, with the rate showing little sign of abating over time (15). Taking advantage of the innovative research avenues opened by linked household survey and healthcare administrative data sources (16,17), we examine the role of individuals' sense of community belonging with the risk of hospitalization among the aging Canadian population living with diabetes.…”

Section: Introductionmentioning

confidence: 99%

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Reduced Risk of Hospitalization With Stronger Community Belonging Among Aging Canadians Living With Diabetes: Findings From Linked Survey and Administrative Data

Gupta

Sheng

2021

Front. Public Health

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Background: Social isolation has been identified as a substantial health concern in aging populations, associated with adverse chronic disease outcomes and health inequalities; however, little is known about the interconnections between social capital, diabetes management, and hospital burdens. This study aimed to assess the role of community belonging with the risk of potentially avoidable hospitalization among aging adults living with diabetes in Canada.Methods: The study leveraged a novel resource available through Statistics Canada's Social Data Linkage Environment: the Canadian Community Health Survey linked to administrative health records from the hospital Discharge Abstract Database. A population-representative sample of 13,580 community-dwelling adults aged 45 and over with diabetes was identified. Multiple logistic regression was used to assess the association of individuals' sense of community belonging with the risk of diabetes-related hospitalization over the period 2006–2012.Results: Most (69.9%) adults with diabetes reported a strong sense of belonging to their local community. Those who reported weak community belonging were significantly more likely to have been hospitalized for diabetes (χ2 = 13.82; p < 0.05). The association between weak community attachment and increased risk of diabetes hospitalization remained significant [adjusted OR: 1.80 (95%CI: 1.12–2.90)] after controlling for age, education, and other sociodemographic and behavioral factors.Conclusion: The COVID-19 pandemic has resurfaced attention to the need to better address social capital and diabetes care in public health strategies. While the causal pathways are unclear, this national study highlighted that deficits in social attachments may place adults with diabetes at greater risk of acute complications leading to hospitalization.

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“…12,15 Insufficient food intake could also affect the bioavailability of medications that require food for metabolism. [16][17][18] Suboptimal health care utilization and health outcomes due to food insecurity 12,[19][20][21][22][23] could Cancer December 15, 2021 lead to avoidable health care utilization and spending and further worsen food insecurity and thereby lead to a vicious cycle of poorer health outcomes and more food insecurity. [24][25][26][27] These mechanisms have implications for suboptimal health care utilization, such as delayed care, decreased likelihood of health care provider visits, or increased likelihood of overnight hospital stays, and for health outcomes, such as self-reported health, among cancer survivors.…”

Section: Introductionmentioning

confidence: 99%

Black‐White racial disparities in health care utilization and self‐reported health among cancer survivors: The role of food insecurity

Ojinnaka

Bruening

2021

Cancer

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BACKGROUND: Non-Hispanic Blacks continue to have worse cancer outcomes than non-Hispanic Whites. Suboptimal health care utilization and poor self-reported health among non-Hispanic Blacks contribute to these disparities. The relationship between race, food security status (FSS), and health care utilization or self-reported health among cancer survivors is not clear. This study aims to fill this gap in the science. METHODS: The 2011-2018 National Health Interview Survey data were used. Bivariate and multivariable logistic regression analyses were used to examine the relationship between race (non-Hispanic Whites or non-Hispanic Blacks), FSS (high, marginal, low, or very low), health care utilization, and self-reported health among cancer survivors. Analyzed health care utilization measures included cost-related medication underuse (CRMU), cost-related delayed care, cost-related forgone care, seeing/talking to a medical specialist, seeing/talking to a general doctor, and overnight hospital stay. RESULTS: A higher proportion of Blacks reported very low food security in comparison with Whites (10.58% vs 4.24%; P ≤ .0001). Blacks were significantly less likely to report a medical specialist visit and more likely to report fair/poor health in the past 12 months even after adjustments for FSS. There was a dose-response relationship between FSS and CRMU, cost-related delayed care, cost-related forgone care, overnight hospital stay, and self-reported health status for both Whites and Blacks. CONCLUSIONS: Significant disparities in health care utilization and self-reported health across race and FSS persist among cancer survivors. Interventions that target food insecurity have the potential to reduce suboptimal health care utilization and self-reported health among cancer survivors. Cancer 2021;127:4620-4627.

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Population-based study of the association between food insecurity and preventable hospitalization among persons with diabetes using linked survey and administrative data

Cited by 5 publications

References 27 publications

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Reduced Risk of Hospitalization With Stronger Community Belonging Among Aging Canadians Living With Diabetes: Findings From Linked Survey and Administrative Data

Black‐White racial disparities in health care utilization and self‐reported health among cancer survivors: The role of food insecurity

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