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Florida Public Health Review

Publication Date

5-22-2023

Abstract

Background: Diabetes is a chronic disease that affects millions of people in the United States. Compliance with treatment plans is important for preventing life-threatening complications of the disease. However, many diabetics forgo recommended testing and other management standards due to lack of health insurance.

Purpose: This study aims to assess the effect of health insurance status on compliance with diabetes care.

Methods: This study was a secondary analysis using 2005–2018 National Health and Nutrition Examination Survey data. For participants who reported having diabetes, compliance with care was assessed based on insurance status. Compliance indicators included hemoglobin A1C check by a doctor in the past year, seeing a diabetes specialist in the past two years, taking diabetic pills to lower blood sugar, and taking insulin. Weighted multivariable logistic regression was used to examine the relationship between insurance status and compliance with diabetes care.

Results: Of participants who reported having diabetes (n=5,152), there were clear sociodemographic differences in insurance status. Uninsured individuals were less likely to have their A1C checked by a doctor in the past year (aOR=0.25, 95% CI=0.18-0.35), to have seen a diabetes specialist in the past two years (aOR=0.77, 95% CI=0.60-0.99), or to be currently taking insulin (aOR=0.58, 95% CI=0.43-0.80) when compared to those who were insured. Uninsured individuals who were male, had less than high school education, or had an income below the federal poverty level were much less likely to have their A1C checked by a doctor in the past year or to be currently taking insulin when compared to their insured counterparts.

Discussion: Health insurance status plays an important role in compliance with diabetes care and management. There is a need for improved access to care and affordable insurance options for those with diabetes to prevent serious complications of the disease.

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