You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

The Relationship Between County-Level Contextual Characteristics and Use of Diabetes Care Services

Luo, Huabin PhD; Beckles, Gloria L. A. MD, MSc; Zhang, Xinzhi MD, PhD; Sotnikov, Sergey PhD; Thompson, Ted MS; Bardenheier, Barbara PhD

Journal of Public Health Management & Practice:
doi: 10.1097/PHH.0b013e31829bfa60
Original Articles
Abstract

Objectives: To examine the relationship between county-level measures of social determinants and use of preventive care among US adults with diagnosed diabetes. To inform future diabetes prevention strategies.

Methods: Data are from the Behavioral Risk Factor Surveillance System (BRFSS) 2004 and 2005 surveys, the National Diabetes Surveillance System, and the Area Resource File. Use of diabetes care services was defined by self-reported receipt of 7 preventive care services. Our study sample included 46 806 respondents with self-reported diagnosed diabetes. Multilevel models were run to assess the association between county-level characteristics and receipt of each of the 7 preventive diabetes care service after controlling for characteristics of individuals. Results were considered significant if P < .05.

Results: Controlling for individual-level characteristics, our analyses showed that 7 of the 8 county-level factors examined were significantly associated with use of 1 or more preventive diabetes care services. For example, people with diabetes living in a county with a high uninsurance rate were less likely to have an influenza vaccination, visit a doctor for diabetes care, have an A1c test, or a foot examination; people with diabetes living in a county with a high physician density were more likely to have an A1c test, foot examination, or an eye examination; and people with diabetes living in a county with more people with less than high-school education were less likely to have influenza vaccination, pneumococcal vaccination, or self-care education (all P < .05).

Conclusions: Many of the county-level factors examined in this study were found to be significantly associated with use of preventive diabetes care services. County policy makers may need to consider local circumstances to address the disparities in use of these services.

In Brief

The objectives of this article are to examine the relationship between county-level measures of social determinants and use of preventive care among US adults with diagnosed diabetes and to inform future diabetes-prevention strategies.

Author Information

Oak Ridge Institute for Science and Education (ORISE) Fellow, Office for State, Tribal, Local, and Territorial Support (OSTLTS), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia (Dr. Luo); OSTLTS, CDC (Dr. Sotnikov); Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC (Drs. Beckles, Zhang, Thompson, and Bardenheier).

Correspondence: Huabin Luo, PhD, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, 1600 Clifton Rd M/S: E-70, Atlanta, GA 30333 (vbz7@CDC.gov).

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

There is no conflict of interest to report.

© 2014 Lippincott Williams & Wilkins, Inc.