دورية أكاديمية
أعرض في EDS

Enrollment in High-Deductible Health Plans and Incident Diabetes Complications.

التفاصيل البيبلوغرافية
العنوان: Enrollment in High-Deductible Health Plans and Incident Diabetes Complications.
المؤلفون: McCoy RG; Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore.; University of Maryland Institute for Health Computing, Bethesda.; Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore.; Department of Health Policy and Management, University of Maryland School of Public Health, College Park.; OptumLabs, Eden Prairie, Minnesota., Swarna KS; OptumLabs, Eden Prairie, Minnesota.; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota., Jiang DH; Stanford Law School, Stanford, California., Van Houten HK; OptumLabs, Eden Prairie, Minnesota.; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota., Chen J; Department of Health Policy and Management, University of Maryland School of Public Health, College Park., Davis EM; University of Maryland Institute for Health Computing, Bethesda.; Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore., Herrin J; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
المصدر: JAMA network open [JAMA Netw Open] 2024 Mar 04; Vol. 7 (3), pp. e243394. Date of Electronic Publication: 2024 Mar 04.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Chicago, IL : American Medical Association, [2018]-
مواضيع طبية MeSH: Diabetes Complications*/epidemiology , Diabetes Mellitus*/therapy , Heart Failure* , Myocardial Infarction*/epidemiology , Kidney Failure, Chronic* , Retinal Diseases* , Stroke*, Adult ; Humans ; Female ; Middle Aged ; Male ; Retrospective Studies ; Deductibles and Coinsurance ; Blindness
مستخلص: Importance: Preventing diabetes complications requires monitoring and control of hyperglycemia and cardiovascular risk factors. Switching to high-deductible health plans (HDHPs) has been shown to hinder aspects of diabetes care; however, the association of HDHP enrollment with microvascular and macrovascular diabetes complications is unknown.
Objective: To examine the association between an employer-required switch to an HDHP and incident complications of diabetes.
Design, Setting, and Participants: This retrospective cohort study used deidentified administrative claims data for US adults with diabetes enrolled in employer-sponsored health plans between January 1, 2010, and December 31, 2019. Data analysis was performed from May 26, 2022, to January 2, 2024.
Exposures: Adults with a baseline year of non-HDHP enrollment who had to switch to an HDHP because their employer offered no non-HDHP alternative in that year were compared with adults who were continuously enrolled in a non-HDHP.
Main Outcomes and Measures: Mixed-effects logistic regression models examined the association between switching to an HDHP and, individually, the odds of myocardial infarction, stroke, hospitalization for heart failure, lower-extremity complication, end-stage kidney disease, proliferative retinopathy, treatment for retinopathy, and blindness. Models were adjusted for demographics, comorbidities, and medications, with inverse propensity score weighting used to account for potential selection bias.
Results: The study included 42 326 adults who switched to an HDHP (mean [SD] age, 52 [10] years; 19 752 [46.7%] female) and 202 729 adults who did not switch (mean [SD] age, 53 [10] years; 89 828 [44.3%] female). Those who switched to an HDHP had greater odds of experiencing all diabetes complications (odds ratio [OR], 1.11; 95% CI, 1.06-1.16 for myocardial infarction; OR, 1.15; 95% CI, 1.09-1.21 for stroke; OR, 1.35; 95% CI, 1.30-1.41 for hospitalization for heart failure; OR, 2.53; 95% CI, 2.38-2.70 for end-stage kidney disease; OR, 2.23; 95% CI, 2.17-2.29 for lower-extremity complication; OR, 1.17; 95% CI, 1.13-1.21 for proliferative retinopathy; OR, 2.35; 95% CI, 2.18-2.54 for blindness; and OR, 2.28; 95% CI, 2.15-2.41 for retinopathy treatment).
Conclusions and Relevance: This study found that an employer-driven switch to an HDHP was associated with increased odds of experiencing all diabetes complications. These findings reinforce the potential harm associated with HDHPs for people with diabetes and the importance of affordable and accessible chronic disease management, which is hindered by high out-of-pocket costs incurred by HDHPs.
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معلومات مُعتمدة: K23 DK114497 United States DK NIDDK NIH HHS
تواريخ الأحداث: Date Created: 20240322 Date Completed: 20240325 Latest Revision: 20240325
رمز التحديث: 20240325
مُعرف محوري في PubMed: PMC10960199
DOI: 10.1001/jamanetworkopen.2024.3394
PMID: 38517436
قاعدة البيانات: MEDLINE
الوصف
تدمد:2574-3805
DOI:10.1001/jamanetworkopen.2024.3394