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County-Level Socioeconomic Disparities in Use of Medical Services for Management of Infections by Medicare Beneficiaries With Diabetes—United States, 2012

Chang, Man-Huei, MPH; Beckles, Gloria L., MD, MSc; Moonesinghe, Ramal, PhD; Truman, Benedict I., MD, MPH

Journal of Public Health Management and Practice: October 01, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000000800
Research Full Report: PDF Only

Objective: To assess county-level socioeconomic disparities in medical service usage for infections among Medicare beneficiaries with diabetes (MBWDs) who had fee-for-service health insurance claims during 2012.

Design: We used Medicare claims data to calculate percentage of MBWDs with infections.

Setting: Medicare beneficiaries.

Participants: We estimated the percentage of MBWDs who used medical services for each of 3 groups of infections by sex and quintiles of the prevalence of social factors in the person's county of residence: anatomic site-specific infections; pathogen-specific infections; and HHST infections (human immunodeficiency virus/acquired immunodeficiency syndrome, viral hepatitis, sexually transmitted diseases, and tuberculosis).

Main Outcome Measures: Using quintiles of county-specific socioeconomic determinants, we calculated absolute and relative disparities in each group of infections for male and female MBWDs. We also used regression-based summary measures to estimate the overall average absolute and relative disparities for each infection group.

Results: Of the 4.5 million male MBWDs, 15.8%, 25.3%, and 2.7% had 1 or more site-specific, pathogen-specific, and HHST infections, respectively. Results were similar for females (n = 5.2 million). The percentage of MBWDs with 1 or more infections in each group increased as social disadvantage in the MBWDs' county of residence increased. Absolute and relative county-level socioeconomic disparities in receipt of medical services for 1 or more infections (site- or pathogen-specific) were 12.9 or less percentage points and 65.5% or less, respectively. For HHST infections, percentage of MBWDs having 1 or more HHST infections for persons residing in the highest quintile (Q5) was 3- to 4-fold higher (P < .001) than persons residing in the lowest quintile (Q1).

Conclusions: Infection burden among MBWDs is generally associated with county-level contextual socioeconomic disadvantage, and the extent of health disparities varies by infection category, socioeconomic factor, and quintiles of socioeconomic disadvantage. The findings imply ongoing need for efforts to identify effective interventions for reducing county-level social disparities in infections among patients with diabetes.

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) (Ms Chang and Dr Truman), National Center for Chronic Disease Prevention and Health Promotion (Dr Beckles), and Office of Minority Health and Health Equity (Dr Moonesinghe), Centers for Disease Control and Prevention, Atlanta, Georgia.

Correspondence: Man-Huei Chang, MPH, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mail Stop E-07, Atlanta, GA 30329 (

The authors thank the staff of the Centers for Medicare & Medicaid Services for their data support and disclosure view, staff in the Chronic Condition Warehouse Help Desk for software and technical support, and staff in the Centers for Disease Control and Prevention's Center for Surveillance, Epidemiology, and Laboratory Services for their administrative support. The authors extend special thanks to C. Kay Smith, MEd, CDC, for editorial support. The study abstract was presented at the American Public Health Association 2016 Annual Meeting and Expo, Denver, Colorado, October 29 to November 2, 2016.

Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.

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

None of the authors have any financial interest in the subject matter or materials discussed in the manuscript.

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