Healthcare Utilization, Diabetes Prevalence, and Comorbidities: Examining Sex Differences among American Indian and Alaska Native Peoples
ISBN: 978-1-83982-799-0, eISBN: 978-1-83982-798-3
Publication date: 28 September 2020
Abstract
Purpose – To examine potential sex differences among American Indian and Alaska Native peoples (AIANs) in diabetes prevalence, comorbidities, healthcare utilization, and treatment costs within the Indian Health Services (IHS).
Methodology/Approach – Data were drawn from the IHS Improving Healthcare Delivery Data Project with 437,608 persons in our analytical sample. We described sex and age differences in diabetes, comorbidities, healthcare utilization, and treatment costs among the adults with diabetes. We evaluated the statistical differences between men and women using confidence intervals calculated at the 95% level, with nonoverlapping confidence intervals indicating statistical significance.
Findings – The prevalence of diabetes among females was somewhat higher than that of males (10.82 vs 9.16%, respectively, p < 0.05). Among adults with diabetes, males had statistically higher prevalence of hypertension, cardiovascular disease, and substance use disorders and fewer mental health disorders compared to females. Although males had overall lower average cost of services than females, males had higher utilization for hospital inpatient services than females, and females used more outpatient services.
Research limitations/implications – We are limited to one fiscal year of data and thus cannot predict the influence of healthcare utilization patterns on the overall health of this population. Although a large sample, the findings are only generalizable to the active users of the participating IHS Service Units.
Originality/Value of Paper – This study fills a major gap in our knowledge of sex differences in diabetes prevalence, comorbidities, healthcare utilization, and treatment costs among AIANs. Differences in the comorbidities that characterized the AIAN adult males and females with diabetes in this sample have important implications for mortality and cost of care. Diabetes management that addresses such gender-specific comorbidities, particularly substance use disorders among men and mental health disorders among women, promises to reduce these comorbidities and related complications.
Keywords
Acknowledgements
Acknowledgments
This work was conducted with guidance and advice of colleagues at the Indian Health Service (IHS), including the IHS National Institutional Review Board (IRB); an IHS subcontractor Sue Ehrhart; and members of the project's Steering, Health Information, and Patient Committees who meet regularly to provide consultation on the project. The project includes data for many American Indian and Alaska Native communities. It would not have been possible to conduct this project without the support and approval of Tribal IRBs, Tribal Councils, and Tribal Authorities who educate us about the health concerns they have for their Tribal members and how they hope this project will inform their work.
This study was supported by the Patient Centered Outcomes Research Institute contract number AD-1304-6451 (Dr Joan O'Connell, Principal Investigator) and the Agency for Healthcare Research and Quality contract number 290-2006-00020-I (Dr Joan O'Connell, Research Principal Investigator).
Citation
Huyser, K.R., Rockell, J., Wilson, C., Manson, S.M. and O'Connell, J. (2020), "Healthcare Utilization, Diabetes Prevalence, and Comorbidities: Examining Sex Differences among American Indian and Alaska Native Peoples", Kronenfeld, J.J. (Ed.) Race, Ethnicity, Gender and Other Social Characteristics as Factors in Health and Health Care Disparities (Research in the Sociology of Health Care, Vol. 38), Emerald Publishing Limited, Leeds, pp. 33-47. https://doi.org/10.1108/S0275-495920200000038007
Publisher
:Emerald Publishing Limited
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