Health Services Use and Health Status Among People with Diabetes Mellitus and Cardiovascular Diseases

Introduction. Diabetes mellitus (DM) is a prevalent chronic disease and has a great impact on health care costs and health status in the United States. DM has been identified as a significant contributor of cardiovascular diseases (CVD), including heart diseases and stroke. Studies have indicated that people with DM, with or without CVD, experience functional difficulties, including poorer status in activities of daily living (ADL) and instrumental activities of daily living (IADL), and self-rated health compared with people without those diseases. Furthermore people with DM and CVD were found to have increased number of health services use. Despite the growing literature on DM and CVD, there is no study of population-based research that has longitudinally examined a broad range of health services use and assessed the association between health services use and  health status among people with DM and CVD.

Methods. This study adopted Andersen's Behavioral Model of Health Services Utilization as a framework to examine health services uses and to identify the association of health services use (doctor visit, prescription drug use, outpatient surgery, hospitalization, home health care, nursing home) and health status (self-rated health, ADL & IADL limitations) within a representative sample of American population through a longitudinal analysis of the Health and Retirement Study data (1998-2010). Cumulative-logit regression models with generalized estimating equations procedure were performed. All the analyses were adjusted for complex sampling design effects.

Results.The primary results indicated that diabetic patients with CVD were more likely to have hospital admissions (OR=1.78, 95% CI=1.58-2.01), home health care (OR=1.42, 95% CI=1.19-1.69), and nursing home admissions (OR=1.45, 95% CI=1.11-1.89) compared to those without CVD. Among diabetic patients with CVD, people with a history of home health care use were more likely to experience improved to unchanged health status compared to those who did not use home health care (OR=1.28, 95% CI=1.01-1.63 ). DM is one of the most prevalent chronic diseases in the United States and those with DM have complex health care needs due to higher risk of developing CVD such as heart diseases and stroke. In this study, people with DM and CVD showed the poorest ADL, IADL, and self-rated health. Compared with people with DM only, diabetes patients with CVD were more likely to have institutionalized care from hospital and nursing home, and home health care services. In addition, utilization for most health services were showed to be associated with worse or lower status in ADL, IADL, or self-rated health in this study. The association between prescription drug use and IADL function, and home health care and self-rated health was different by health groups. The use of home health care among people with DM and CVD was associated with an improved to unchanged self-rated health.

Conclusions.Diabetic patients with CVD were more likely to have received institutionalized care (from hospitals and nursing homes) and home health care services compared with diabetics without CVD. Utilization for most health services were shown to be associated with worse self-rated health, ADL, and IADL status.