Racial-Ethnic Disparities in Access to Preventive Services Among Privately Insured Adults With Disabilities

Introduction Cerebral palsy (CP) and spina bifida (SB) are congenital disabilities. Due to life-long disability, adults with CP/SB are with greater needs for preventative care. Little is known about racial/ethnic disparities in use of preventative services in this population. Our objective was to examine racial/ethnic disparities in use of preventative care. Methods Using 2007-2017 private claims data, we identified White, Black, and Hispanic adults (18+) with CP/SB [n=11,635; White=8,935; Black=1,457; Hispanic=1,243)]. We quantified the National Institute of Medicine (NAM) definition of disparity by matching health related variables (age, sex, comorbid conditions, and Elixhauser index) between Whites and each minority subpopulation. Generalized estimating equations were used and all models were adjusted for age, sex, comorbidities, income, education, and U.S. Census divisions. Outcomes of interest were: (1) any office visit; (2) any physical therapy/ occupational therapy (PT/OT); (3) annual wellness visit; (4) bone density screening; (5) cholesterol screening; (6) diabetes screening. Results Rate of recommended services for all adults with CP/SB were low and no significant results were found for most preventative services across race/ethnicity. Compared with Whites, Hispanics had lower odds of annual wellness visit (OR: 0.71; 95% CI: 0.53, 0.96) but higher odds of diabetes screening (OR: 1.48; 95% CI: 1.13, 1.93). Blacks had lower odds of bone density screening (OR: 0.54; 95% CI: 0.31-0.95), and annual wellness visit (OR: 0.50; 95% CI: 0.24-1.00). Conclusions There were no substantial racial/ethnic disparities in use of preventive services among privately insured adults with CP/SB who had a higher-than-average income and education level.

Early Diagnosis of Prediabetes Among Pregnant Women that Develop Gestational Diabetes Mellitus and Its Influence on Perinatal Outcomes

Objective: This purpose of this study was to determine among pregnant women with gestational diabetes (GDM) if early identification of impaired glucose tolerance consistent with prediabetes in the first trimester impacts maternal and neonatal outcomes. Study Design: This was a retrospective cohort study of patients that were screened for pregestational diabetes in early pregnancy at a large academic tertiary care center from October 1, 2017 to January 31, 2021 and who subsequently developed GDM. Demographic and perinatal outcomes were compared among women with GDM with a positive early diabetes screen consistent with prediabetes to women that screened negative in the first trimester. Multivariable logistic regression was performed to adjust for baseline demographic differences. Results: During the study period, 260 women screened had negative first trimester diabetes screening and subsequently developed GDM, while 696 screened positive for prediabetes and developed GDM. Women with prediabetes were more likely to require insulin treatment for their GDM compared to those that screened negative (79.5% vs. 45.4%, p<0.001), while those that screened negative were more likely to take an oral medication of metformin or glyburide for GDM management than those with prediabetes (41.5% vs. 16.4%, P<0.001). Infants born to mothers who screened positive for prediabetes were more likely to require NICU admission compared to those that screened negative even when adjusted for type of GDM treatment used (aOR 8.5, 95% CI 1.5-49.9). Conclusion: Women identified as having early impaired glucose tolerance consistent with prediabetes that subsequently develop gestational diabetes are more likely to be prescribed insulin treatment and may be at increased risk of adverse neonatal outcomes leading to NICU admission than women with negative first trimester diabetes screening. Future studies should focus on whether different methods of early treatment and/or intervention improve perinatal outcomes.