Abstract
Objective
Examine the relationship between food and housing insecurities, quality of care and quality of life in adults with diabetes using a nationally representative data source.
Methods
Data from 39,604 adults with diabetes who indicated if they experienced food and/or housing insecurity in the Behavioral Risk Factor Surveillance System (2014, 2015, 2017) was analyzed. Outcomes included quality of care (HbA1c test, eye exam, diabetes education, foot check) and quality of life (general health status, poor physical and mental health days, poor overall health days). Logistic models were run for each quality of care measure and linear models were run for each quality of life measure adjusting for socio-demographics, insurance status, and comorbidity count.
Results
35.6% of adults with diabetes reported housing insecurity, 31.8% reported food insecurity, and 23.4% reported both. After adjustment, food and housing insecurity was significantly associated with lower odds of having an eye exam (housing:0.73, 95%CI:0.63,0.85; food:0.78, 95%CI:0.67,0.92; both:0.69, 95%CI:0.59,0.82), worse general health status (housing:-0.06 95%CI:-0.11,-0.01; food:-0.16, 95%CI:-0.21,-0.10; both:-0.14, 95%CI:-0.20,-0.09), and an increased number of poor mental health days (housing:1.73, 95%CI:0.83,2.63; food:2.08, 95%CI:1.16,3.00; both:1.97, 95%CI:1.05,2.90). Food insecurity was also associated with lower odds of receiving diabetes education (0.86, 95%CI:0.74,0.99) and an increased number of poor physical health days (0.95, 95%CI:0.14,1.76).
Conclusion
Changes to our healthcare delivery system are critical to improving standards of care and quality of life in all populations and may require a shift towards consideration of overlapping social risk factors rather than the siloed approach currently used.
Funder
National Institute of Diabetes and Digestive and Kidney Diseases
National Institute for Minority Health and Health Disparities
American Diabetes Association
Publisher
Public Library of Science (PLoS)
Reference45 articles.
1. 1. Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes—2019;American Diabetes Association;Diabetes Care,2019
2. Achievement of goals in US diabetes care, 1999–2010;MK Ali;N Engl J Med,2013
3. Evaluation of the cascade of diabetes care in the United States, 2005–2016;P Kazemian;JAMA Intern Med,2019