Date of Award

Spring 5-15-2020

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Ike S. Okosun

Second Advisor

Dr. Shanta R. Dube

Abstract

ABSTRACT

ASSOCIATION BETWEEN HEALTH INSURANCE AND UNDIAGNOSED DIABETES: NHANES 2013-2016

By

KOMAL PATEL

15th MAY 2020

BACKGROUND: Given the insidious nature of type 2 diabetes, there is a percentage of the population that goes undiagnosed. Studies suggest that undiagnosed population may be at higher risk of developing diabetes-related macrovascular and microvascular complications.

Therefore, it is crucial to identify factors that may be associated with undiagnosed diabetes. Access to healthcare and other socioeconomic factors have been researched in the past; however, little is known regarding the role of health insurance in the screening of undiagnosed diabetes.

AIM: The aim of this study is to determine the three most commonly used types of health insurance (Medicare, Medicaid, and Private) among American subjects with undiagnosed diabetes. The study also sought to determine the type of health insurance that is mostly associated with undiagnosed diabetes.

METHODS: Publicly available NHANES data files for the year 2013-2016 were used for the analysis. SAS survey procedures were used to estimate weighted frequencies of undiagnosed diabetes and types of health insurance in the target population. Multivariate logistic regression was carried out to estimate the association between health insurance and undiagnosed diabetes.

RESULTS: Overall, 6.18% of the target population had undiagnosed diabetes. The prevalence of undiagnosed diabetes was higher among males (3.19%) and adults aged 60 and above (2.17%). Among those who had undiagnosed diabetes, 5.33% had health insurance, and less than 1% reported a lack of health insurance. Medicare insurance was associated with undiagnosed diabetes (aOR 1.61, 95% 1.07 – 2.42) as compared to other health insurance. This finding was statistically significant at p<0.05.

DISCUSSION: The prevalence of undiagnosed diabetes was higher in older adults aged 60 and above. This could be attributed to the increased prevalence of diabetes in older adults in the US. Results also indicate that males have a higher percentage of undiagnosed diabetes as compared to females. Medicare was significantly associated with undiagnosed diabetes. This may indicate that some policy reforms are required to improve diabetes screening services in this program. More research is needed to understand other factors associated with undiagnosed diabetes and reduce its prevalence in the U.S.

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