Racial disparities in healthcare utilization and costs in pharmacologically treated medicaid enrollees with developmental disabilities and Type 2 diabetes
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Objective: Adults with developmental disabilities have higher prevalence of chronic disease conditions such as diabetes, obesity, high blood pressure, arthritis, CVD and chronic pain. They also have poor healthcare utilization and are screened less for chronic disease conditions. Very few studies have looked at the diabetes related health outcomes in developmentally disabled adults, where distinct racial differences in medication use behaviors have been observed. The objective of this study was to examine the association of race with healthcare utilization and costs in pharmacologically treated Medicaid enrollees with developmental disabilities (DD) and type 2 diabetes. Methods: This was a retrospective cohort study that identified adults with DD and type 2 diabetes from the MarketScan Multi-State Medicaid Database. Enrollees aged 18-64 years who received new medications for type 2 diabetes from January 1, 2004 and December 31, 2006 were included. An index diagnosis date was assigned to each patient and adults with a continuous enrollment for at least 12 months were included. Probabilities of type 2 diabetes related healthcare utilization (inpatient, outpatient and emergency department visits) in adults with DD were computed using multivariate logistic regression models. Multivariate negative binomial regression was used to measure the rate of change in type 2 diabetes related healthcare utilization in patients with DD. Multivariate linear regression with log-transformation was used to determine type 2 diabetes related healthcare costs in Medicaid enrollees with DD. Results: This study had a sample size of 1529 patients. After controlling for all the covariates, compared to Caucasians with DD, African Americans with DD were more likely to have type 2 diabetes related inpatient (OR=1.71; 95% CI, 1.02-2.85) and emergency department visits (OR, 1.67; 95% CI, 1.02-2.73). African Americans with DD and type 2 diabetes had significantly higher healthcare costs compared to Caucasians with DD and type 2 diabetes. Conclusion: Racial disparities exist in healthcare utilization in Medicaid patients with DD and type 2 diabetes. African Americans were more likely to have inpatient and ER visits respectively. Also, African Americans were more likely to have higher type 2 related healthcare costs compared to Caucasians.
