Background: Among adults with type 2 diabetes, racial and ethnic minorities have significantly higher rates of potentially preventable hospitalizations (PPH) compared to White non-Hispanic adults. Depression, anxiety, and stress-related disorders are associated with increased risk of diabetes related PPH. We examined the interaction of these risk factors among Medicaid enrollees.

Methods: This study used 2014 Medicaid claims data from 17 US states. The sample included 1,049,790 adults with type 2 diabetes. The outcome was >=1 diabetes related PPH, defined by the AHRQ Prevention Quality Diabetes Composite measure. Predictors were race/ethnicity and mental health diagnoses (PTSD, adjustment disorder, generalized anxiety disorder [GAD], phobic disorders, and depressive disorders). Logistic regression models examined the adjusted main-effects and interactions of both predictors on PPH, adjusting for clinical and demographic characteristics.

Results: Depression was associated with significantly greater odds of PPH (Adjusted Odds Ratio [AOR] = 1.50, 95%CI: 1.47, 1.60). PTSD (AOR = 0.81, 95%CI: 0.69, 0.96) and GAD (AOR = 0.79, 95%CI: 0.68, 0.92) were associated with lower odds of PPH. Black adults had significantly higher odds of PPH (AOR = 1.30, 95%CI: 1.26, 1.34) and Hispanic adults had significantly lower odds of PPH (AOR = 0.95, 95%CI: 0.91, 0.99) compared to White non-Hispanic adults. Depression increased odds of PPH among Black adults (AOR = 1.09, 95%CI: 1.03, 1.16) and decreased odds of PPH among Hispanic adults (AOR = 0.87, 95%CI: 0.79, 0.96) compared to White non-Hispanic adults.

Discussion: Of the psychological comorbidities examined, only depression was associated with increased risk of diabetes related PPH. Results suggest that depressive symptoms may exacerbate racial and ethnic disparities in PPH. Adults with PTSD or GAD diagnoses may have greater engagement with preventive healthcare and thus, lower risk of PPH.


A. A. Lee: None. Y. Zhang: None. S. Ramachandran: None.

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