Doctoral Dissertations
Date of Award
12-2023
Degree Type
Dissertation
Degree Name
Doctor of Philosophy
Major
Comparative and Experimental Medicine
Major Professor
Agricola Odoi
Committee Members
Kristina Kintziger, Louis Rocconi, Russell Zaretzki
Abstract
Background: Understanding disparities in and drivers of adverse diabetes outcomes is important for guiding strategies to improve diabetes management, reducing risks of complications, and eliminating disparities. Thus, studies investigating disparities and predictors of these complications as well as diabetes-related hospitalization (DRH) rates are useful for guiding efforts to reduce these disparities and improve diabetes related health outcomes. Therefore, the objectives of this research were to: (i) identify predictors of severity of diabetes complications; (ii) investigate local geographic disparities of DRH rates; and (iii) identify determinants of geographic disparities of DRH rates and determine if the strengths of associations between the identified determinants and the outcome vary spatially.
Methods: Retrospective analyses were conducted using hospital discharge data from Florida from 2016 to 2019. Population average models, estimated using generalized estimating equations, were used to identify individual- and ZIP code tabulation area (ZCTA)-level predictors of severe diabetes complications. Raw and spatial empirical Bayes smoothed DRH rates were computed at the ZCTA-level. High-rate DRH clusters were identified using Tango’s flexible spatial scan statistic. Ordinary least squares and multiscale geographically weighted regression models were fit to identify predictors of DRH rates and describe spatial heterogeneity of regression coefficients.
Results: Significant predictors of severity of diabetes complications included age, race/ethnicity, gender, comorbidities (hypertension, hyperlipidemia, obesity, depression, and arthritis), type of health insurance coverage, and neighborhood socioeconomic status. The statewide DRH rate was 8.5 per 1,000 person-years. Significant spatial clusters of DRH rates tended to be in rural rather than urban areas. Areas with high DRH rates tended to have higher: (i) proportions of older adults, (ii) non-Hispanic Black residents, and (iii) unemployment rates; and lower: (i) levels of income, (ii) health insurance coverage, and (iii) vehicle access. There was evidence of heterogeneity of regression coefficients at local, regional, and statewide scales.
Conclusions: The identification of high-rate DRH clusters and determinants of severe complications and hospitalization rates provides useful information to guide resource allocation and locally-focused health planning such that communities with the highest burdens are prioritized to reduce the observed disparities and improve diabetes outcomes.
Recommended Citation
Lord, Jennifer, "Geographic Epidemiology of Diabetes-Related Complications and Hospitalizations in Florida. " PhD diss., University of Tennessee, 2023.
https://trace.tennessee.edu/utk_graddiss/9072