Date of Award

2018

Document Type

Open Access Dissertation

Department

Epidemiology and Biostatistics

First Advisor

Kellee White

Abstract

Background: Multiple chronic condition is common in older adults with diabetes. Several prior studies have shown that having multiple chronic condition impact cardiometabolic risk factor controls (i.e., blood pressure, High-density lipoprotein (HDL) cholesterol level, and high glycated hemoglobin (HbA1c). However, it is not clear whether these results extend to a multiethnic sample of older adults.

Objectives: 1). Examine the association between Comorbidity profile and ABCs goals achievement. 2). Examine whether the association between comorbidity profile and ABCs goals achievement is moderated by race/ethnicity.

Methods: A sample of 3532 participants from Health and Retirement Study (HRS) years 2010 and 2012 and corresponding HRS Biomarker data were included in this analysis. Individual without complete diabetes status and those with missing value of all outcome variables were excluded. The main outcome measures were three cardiometabolic risk factor controls (blood pressure control, glycated hemoglobin (HbA1c) control and HDL cholesterol control), which measured based on guideline-defined threshold. Explanatory variables were a participant’s comorbidity profile, characterized by the presence of specific chronic condition types (none, concordant only, discordant only, and both concordant and discordant). Analyses included logistic regression adjusted for survey years, socio-demographic, clinical and lifestyle characteristic factors.

Results: In the final study sample, (66%) were had both concordant and discordant condition, 19% were had only concordant condition, 9% were had only discordant condition, and only 6% were had no other chronic condition beside diabetes. We did not find significant associations between comorbidity profile and Blood pressure control (for concordant: OR: 0.9; 95% CI: (.05- 1.7), discordant: OR: 1.2; 95% CI: (0.6 – 2.1), and both condition: OR: 1.0; 95% CI: (0.6 – 1.8)). Diabetes patient with only discordant chronic condition or both concordant and discordant chronic condition were more likely to have HbA1c controlled than those with no chronic condition beside diabetes (for discordant: OR: 2.37; 95% CI: (1.30 – 4.33) and both condition: OR: 2.15; 95% CI: (1.18 – 3.93). The association between HDL cholesterol and comorbidity profile were modified by race/ethnicity. Having concordant conditions was negatively associated with HDL cholesterol control among Hispanic (OR: 0.36; 95% CI; (0.14 – 0.92). The association was not significant among whites or blacks.

Conclusions: This study shows that Comorbidity profile is associated with ABCs goals achievements among older adults with diabetes. Having discordant chronic conditions makes HbA1c goal achievement more likely. However, having concordant conditions makes HDL cholesterol goal achievement less likely: an effect that varies by race/ethnicity. Future study should further examine the association by using comprehensive set of chronic conditions.

Available for download on Wednesday, August 07, 2019

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