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Geographic and Racial/Ethnic Variations in Patterns of Multimorbidity Burden in Patients with Type 2 Diabetes

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A Capsule Commentary to this article was published on 01 November 2014

ABSTRACT

Background

Multimorbidity presents a significant public health challenge, but regional, rural/urban, and racial/ethnic differences in patterns of multimorbidity in diabetes are poorly understood.

Objective

To describe patterns of multimorbidity in medical and mental health by regional, rural/urban, and racial/ethnic variation in patients with type 2 diabetes mellitus.

Design

Retrospective cohort study from 2002 through 2006

Participants

A national cohort of 892,223 veterans with diabetes

Main Measures

Multimorbidity was the main outcome defined as: the measure of multimorbidity and two categorical outcomes, with pattern of medical and mental health comorbidities combined and separately.

Key Results

Among patients, 52% had 2+ comorbidities, 33% had a single comorbidity, and 14% had no comorbidity; 13.9% had both medical and mental health comorbidities, 70.3% had medical only, and 1.5% had mental health only. The odds of having 3+ comorbidities were nearly fourfold greater in patients 75 years and older relative to patients younger than 50 years (OR=3.95 [95% CI: 3.84, 4.06]). Compared to non-Hispanic whites, the odds of 3+ comorbidities among non-Hispanic blacks were 1.67 times greater (95% CI: 1.63, 1.71). Hispanics were more likely to have a mental health comorbidity alone (OR=1.20 [95% CI: 1.13, 1.28]) than non-Hispanic whites. For patients living in rural areas, the odds were higher of having 3+ comorbidities (OR=1.21 [95% CI: 1.19, 1.23]) and of having both medical and mental health comorbidities (OR=1.15 [95% CI: 1.13, 1.17]) compared to urban dwellers.

Conclusions

Among individuals with diabetes, traditionally disadvantaged groups, including non-Hispanic blacks and rural patients, appear to bear the greatest burden and risk of multimorbidity. Significantly greater odds with increasing number of comorbidities were seen by race/ethnicity, rural residence, and geographic region.

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ACKNOWLEDGMENT

1. This study was supported by grant #IIR-06-219 funded by the VHA Health Services Research and Development (HSR&D) program. The funding agency did not participate in the design or conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. The manuscript represents the views of the authors and does not reflect those of the VA or HSR&D.

2. Drs. Leonard E Egede and Mulugeta Gebregziabher are the guarantors of this work, and as such, had full access to all data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis.

3. This work has not previously been presented.

Conflict of Interest

The authors each declare that they have no conflict of interest.

Authors’ Contributions

Study concept and design: Egede, Gebregziabher, Axon, Hunt, Lynch

Acquisition of data: Egede

Analysis and interpretation of data: Gebregziabher, Hunt, Payne, Egede

Drafting of the manuscript: Egede, Lynch, Gebregziabher, Axon, Hunt, Payne

Critical revision of the manuscript for important intellectual content: Lynch, Gebregziabher, Axon, Hunt, Payne, Egede

Final approval of manuscript: Lynch, Axon, Gebregziabher, Hunt, Egede, Payne

Author information

Authors and Affiliations

  1. Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA

    Cheryl P. Lynch MD, MPH, Mulugeta Gebregziabher PhD, R. Neal Axon MD, MS, Kelly E. Hunt PhD, Elizabeth Payne BS & Leonard E. Egede MD, MS

  2. Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, 135 Rutledge Avenue, MSC 593, Charleston, SC, 29425-0593, USA

    Cheryl P. Lynch MD, MPH, R. Neal Axon MD, MS & Leonard E. Egede MD, MS

  3. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA

    Mulugeta Gebregziabher PhD, Kelly E. Hunt PhD & Elizabeth Payne BS

Authors
  1. Cheryl P. Lynch MD, MPH
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  2. Mulugeta Gebregziabher PhD
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  3. R. Neal Axon MD, MS
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  4. Kelly E. Hunt PhD
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  5. Elizabeth Payne BS
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  6. Leonard E. Egede MD, MS
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Corresponding author

Correspondence to Leonard E. Egede MD, MS.

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Lynch, C.P., Gebregziabher, M., Axon, R.N. et al. Geographic and Racial/Ethnic Variations in Patterns of Multimorbidity Burden in Patients with Type 2 Diabetes. J GEN INTERN MED 30, 25–32 (2015). https://doi.org/10.1007/s11606-014-2990-y

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  • DOI: https://doi.org/10.1007/s11606-014-2990-y

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