Doctoral Dissertations

Orcid ID

https://orcid.org/0000-0003-0879-2762

Date of Award

8-2023

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Public Health

Major Professor

Agricola Odoi

Committee Members

Kathleen C. Brown, Russell Lee Zaretzki, Kristina W. Kintziger

Abstract

The burden of diabetes and diabetes-related Emergency Department (ED) visits has increased in Florida. However, Diabetes Self-management Education (DSME) Program participation remained considerably low. Little is known about disparities of DSME participation, diabetes complications, and ED use by diabetes patients in Florida and yet this information is important for guiding health programs aimed at reducing diabetes burden. Therefore, the objectives of this study were to investigate: (a) disparities of diabetes prevalence and DSME participation; (b) disparities of diabetes-related ED visit risks; and (c) prevalence and predictors of stroke among persons with prediabetes and diabetes.

Behavioral Risk Factor Surveillance System and ED data were obtained from the Florida Department of Health and the Agency for Healthcare Administration, respectively. Data were aggregated to the county level. Temporal changes of diabetes prevalence, DSME participation, and ED visit were investigated. High-risk spatial clusters were identified using Tango’s flexible and Kulldorff’s circular spatial scan statistics. Predictors of DSME participation, ED visit, and stroke were investigated using ordinary least square and logistic regression models. Geographic distribution of significant (p≤0.05) spatial clusters and predictors were displayed on maps.

There were significant (p≤0.05) increases in age-adjusted diabetes prevalence, DSME participation rates, and ED visit risks over time. Clusters of high diabetes prevalence and ED visit risks were identified in northern and central Florida, while clusters of high DSME participation rates were observed in central Florida. Rural counties and those with high proportions of Hispanic populations had low DSME participation rates. Counties with high proportions of populations that were Black, current smokers, uninsured, or with diabetes had significantly higher diabetes-related ED visit risks, while counties with high proportions of married individuals had significantly low ED visit risks. Individuals with prediabetes had high odds of strokes if they were ≥45 years old, had hypertension and hypercholesterolemia, while those with diabetes had high odds if they were non-Hispanic Black, hypertensive, and had depression.

The identified disparities and predictors of diabetes prevalence, DSME participation, diabetes-related ED visit, and stroke among populations with prediabetes and diabetes are useful in guiding evidence-based health planning and resource allocation in combating the diabetes problem in Florida.

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