Abstract 18420: Regional Variations in Processes of Care and Vascular Morbidity in Diabetic Adults in the United States

Abstract

Background: It is unclear whether geographic variation in processes of care and vascular morbidity exists among diabetics in the U.S. We sought to determine the extent of regional variations in processes of care and their association with vascular disease in a cohort of diabetic adults in the U.S.

Methods and Results: The 2007 Centers for Disease Control Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of diabetic patients. Participant residence was classified based on four U.S. regions: (1) Northeast, (2) Midwest, (3) South, and (4) West. Demographic data, clinical history, processes of care (regular medical checkup, foot exam, eye exam, diabetic education, aspirin use, and antihypertensive use) and vascular morbidity for diabetics of each region were compared. Presence of vascular morbidity was based upon patient report of myocardial infarction, stroke, retinopathy, nonhealing foot sores or bilateral foot amputations. Among the 42,072 diabetics, 43.9% were from the South, while 18.7%, 18.7%, and 18.6% were from the Midwest, Northeast, and South respectively. Diabetics of each region differed significantly with respect to demographic characteristics, prior medical history, and processes of care. Vascular morbidity also differed among the regions such that the West had significantly lower rates of myocardial infarction, while the South had higher rates of stroke and diabetic retinopathy. On multivariate analysis, geographic region was found to be independently associated with processes of care. However, geographic region was not found to be independently predictive of vascular morbidity. Independent variables associated with vascular morbidity included older age (OR, 1.01; 95%CI, 1.01-1.02), male gender (OR, 1.55; 95%CI, 1.43-1.67), employment status, level of education, lower annual income, financial barriers to health care (OR, 1.48; 95%CI, 1.31-1.66), active smoking status (OR, 1.12; 95%CI, 1.03-1.23), hypertension (OR, 1.26; 95%CI, 1.16-1.37) and hypercholesterolemia (OR, 1.23; 95%CI, 1.14-1.34).

Conclusion: Despite significant regional differences in process of care, no regional variations in vascular morbidity were observed in diabetic adults.