Document Type

Capstone Experience

Graduation Date

12-2018

Degree Name

Master of Public Health

Department

Biostatistics

First Committee Member

Dr. Fang Yu

Second Committee Member

Dr. Lorena Baccagllini

Third Committee Member

Sarah Sjolie

Abstract

Background: Over the few decades, diabetes has become one of the most common chronic conditions in the U.S and worldwide. With the increasing number of incidences of diabetes and the cost associated with the treatment, adherence to treatment regimens is one key factor, which immensely affects the success of the diabetes treatment. The American Diabetes Association recommends annual preventive care for diabetes in terms of self-care practices such as daily blood glucose check and daily foot check. An eye examination with pupil dilation and a dental checkup are also recommended as part of annual care for diabetic patients. Considering the effect and the importance of various factors on the emergence of this chronic disease, the purpose of this study was to investigate the demographic and socioeconomic factors impacting the treatment compliance in patients with diabetes.

Objective: To identify the factors associated with the medical and dental compliance among patients with diabetes.

Methods: The analysis was conducted using the Behavioral Risk Factor Surveillance System (BRFSS) data. Both Univariate and Multivariable logistic regressions were used to assess the relationship between the factors (independent) and medical compliance or dental compliance (dependent) among diabetes patients with account for survey design using the SURVEYLOGISTIC procedure in SAS.

Results: The Odds of following medical compliance for diabetic care were higher for female (OR=1.21; 95%CI=1.02-1.43), older patients with age of 65 or older, non-White patients (non-Hispanic Black: OR=1.26; 95%CI=1.02-1.54; Hispanic: OR=1.33; 95%CI=1.02-1.74; Other Non-Hispanic: OR=1.15; 95%CI= 0.76-1.73), married, and with college degree and health coverage plan. Additionally, patients, who had alcoholic beverages within last 30 days (OR=0.67; 95%CI=0.54-0.82) and with good general health status (OR=0.84; 95%CI=0.70-0.99), had lower odds to follow medical compliance.

For annual dentist visit, females had higher odds of dental compliance (OR=1.23; 95%CI=1.12-1.35) as compared to male. Older people (65+) were less compliant as compared to younger patients. Patients with BMI less than 30 had higher odds to visit dentist during past 12 months. All race groups had lower odds to visit dentist annually as compared to white people. Patients with income less than $50000, current (OR=0.60; 95%CI=0.53-0.68) and former smokers (OR=0.81; 95%CI=0.74-0.90) had lower odds to visit dentist. Diabetes patients with college degree, with good health status (OR=1.35; 95%CI=1.23-1.48) and with health coverage plan (OR=1.64; 95%CI=1.31-2.06) had higher odds to follow dental compliance of diabetes.

Conclusion: There are significant disparities in following medical compliance and dental compliance among diabetes patients with different demographic and social-economic variables. A success in reducing or eliminating these disparities will help to improve health outcome relevant to diabetes management. Providers of diabetes care can play a key role in diminishing these disparities through understanding and addressing patient factors such as health literacy and focusing on improved patient communication and cultural competence.


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