Table 4.
Diabetes Care and Transportation Insecurity in Adult CHC Patients With T2DM in 2016‒2020
| Variables | Predicted probability of diabetes outcomes | ||
|---|---|---|---|
| Estimated % (95% CI) | Difference (95% CI) | p-value | |
| Diabetes clinical care outcomes | |||
| Up-to-date HbA1c screening | |||
| Documented: transportation insecurity | 72.9 (68.8, 76.9) | – | |
| Documented: no transportation insecurity | 73.6 (70.3, 76.9) | 0.7 (−2.4, 3.8) | 0.639 |
| Transportation insecurity not assessed | 71.9 (69.8, 74.1) | −0.9 (−4.7, 2.8) | 0.635 |
| Up-to-date urine creatinine screening | |||
| Documented: transportation insecurity | 44.8 (39.6, 49.9) | – | |
| Documented: no transportation insecurity | 46.3 (41.4, 51.2) | 1.5 (−1.0, 4.0) | 0.237 |
| Transportation insecurity not assessed | 41.7 (38.0, 45.5) | −3.1 (−6.7, 0.6) | 0.104 |
| Up-to-date foot screening | |||
| Documented: transportation insecurity | 12.3 (9.2,15.5) | – | |
| Documented: no transportation insecurity | 12.6 (9.7, 15.6) | 0.3 (−1.6, 2.2) | 0.749 |
| Transportation insecurity not assessed | 12.5 (9.7,15.2) | 0.1 (−1.5, 1.7) | 0.883 |
| Up-to-date LDL screening | |||
| Documented: transportation insecurity | 60.8 (57.8, 63.7) | – | |
| Documented: no transportation insecurity | 64.8 (62.4, 67.1) | 4.0 (2.0, 6.0) | <0.001 |
| Transportation insecurity not assessed | 59.7 (57.8, 61.6) | −1.0 (−3.5, 1.4) | 0.402 |
| Active statin prescriptiona | |||
| Documented: transportation insecurity | 72.8 (70.0, 75.6) | – | |
| Documented: no transportation insecurity | 74.0 (72.0, 76.0) | 1.2 (−1.7, 4.0) | 0.414 |
| Transportation insecurity not assessed | 71.2 (69.7, 72.7) | −1.7 (−4.2, 0.8) | 0.190 |
| Diabetes control outcomes | |||
| Controlledb HbA1c, (<9%) | |||
| Documented: transportation insecurity | 73.7 (71.1, 76.4) | – | |
| Documented: no transportation insecurity | 78.5 (76.4, 80.5) | 4.7 (1.5, 8.0) | 0.005 |
| Transportation insecurity not assessed | 78.6 (77.9, 79.3) | 4.9 (2.2, 7.5) | <0.001 |
| Controlled blood pressure, (<140/90 mmHg) | |||
| Documented: transportation insecurity | 71.8 (69.5, 74.1) | – | |
| Documented: no transportation insecurity | 74.1 (72.4, 75.9) | 2.4 (0.3, 4.4) | 0.025 |
| Transportation insecurity not assessed | 73.1 (72.1, 74.2) | 1.3 (−0.9, 3.6) | 0.241 |
| Controlledb LDL, (<100 mg/dL) | |||
| Documented: transportation insecurity | 56.7 (53.0, 60.4) | – | |
| Documented: no transportation insecurity | 60.8 (58.8, 62.8) | 4.1 (1.0, 7.2) | 0.009 |
| Transportation insecurity not assessed | 60.3 (59.2, 61.4) | 3.6 (0.2, 7.0) | 0.040 |
| Visits in year following index, (rate) | |||
| Documented: transportation insecurity | 5.5 (5.2, 5.8) | – | |
| Documented: no transportation insecurity | 5.0 (4.8, 5.2) | −0.4 (−0.7, −0.2) | <0.001 |
| Transportation insecurity not assessed | 4.4 (4.3, 4.6) | −1.0 (−1.3, −0.8) | <0.001 |
Note: Boldface indicates statistical significance (p<0.05).
Estimates were derived using general estimating equations logistic (binary outcomes) or negative binomial (rates outcome) regression and robust sandwich variance estimation for clustering of patients within clinics. For all analyses, regression adjustment was made for sex, race/ethnicity, preferred language, age, and insurance status at the index visit, first known federal poverty level, and yearly rate of primary care visits (except in estimating the rate outcome). Index visit is defined as the first ambulatory visit at least 1 year before their last visit in the electronic health record. Screenings are considered up-to-date if within 183 days after or up to 7 days before the index for HbA1c and 365 days after or up to 7 days before for all others.
Active statin prescription outcome was evaluated in a subset of patients in whom a statin was indicated: patients not pregnant or breastfeeding and who have not been diagnosed with rhabdomyolysis, end-stage renal disease, or renal failure and who are either (1) aged 40‒75 years or (2) aged >21 years with atherosclerotic cardiovascular disease or LDL ≥160 mg/dL (n=54,006).
Controlled HbA1c and LDL outcomes were evaluated in the subsets of patients with up-to-date measures as defined earlier (HbA1c: n=53,669; LDL: n=46,204).
CHC, community health center; LDL, low-density lipoprotein; T2DM, type 2 diabetes mellitus.