Document Type

Capstone Experience

Graduation Date

12-2021

Degree Name

Master of Public Health

Department

Biostatistics

First Committee Member

Kendra Schmid

Second Committee Member

Jianghu (James) Dong

Third Committee Member

Hongying (Daisy) Dai

Abstract

People with severe mental illness tend to die 10-25 years earlier than the general population (WHO). Main contributors to these premature deaths include comorbidities such as hypertension, cardiovascular disease, and diabetes. Diabetes prevalence in mentally ill people is 2 times higher than the general population (WHO). The World Health Organization is taking action to improve the health of people with severe mental illness. These efforts include creating protocols of prevention, identification, assessment, and treatment for mentally ill people, as well as improving access to general health services through the integration of physical and mental health services. Community Alliance, located in Omaha, Nebraska (https://community-alliance.org/), is an integrated mental and physical health facility that aims to fulfill this goal. The purpose of this project was to analyze the Diabetes Registry database at Community Alliance in an effort to help their organization monitor health outcomes of diabetic clients. This observational, retrospective study began with descriptive analysis of the primary outcome variable, glycemic control, and demographic factors including sex, race, ethnicity, insurance, smoking status, comorbidity, medication management, antipsychotic medication use, and primary care provider. Cumulative and binary logistic regression was used to estimate the predictors of poor glycemic control. Effects were interpreted using adjusted odds ratios. Both models were multivariate and adjusted for all variables. Findings indicate that while no significant p-values were reported, Hispanic ethnicity (adjOR 2.24; 95% CI .7-29.32), medication management (adjOR 2.5; 95% CI .45-13.96), and Medicaid insurance (adjOR 1.94; 95% CI .26-14.65) were most strongly associated with higher odds of poor glycemic control in both models. Statistical analysis revealed important relationships that may guide Community Alliance in their effort to evaluate and improve Diabetes patient outcomes.

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