Disparities in diabetes care: impact of mental illness.
BACKGROUND
Emerging evidence indicates that patients with mental health conditions (MHCs) may receive less intensive medical care. Diabetes serves as a useful condition in which to test for MHC-related disparities in care. We examined whether quality measures for diabetes care are worse for patients with or without MHCs.


METHODS
This national, cross-sectional study included 313 586 noninstitutionalized Veterans Health Administration patients with diabetes (identified from diagnostic codes and prescriptions) whose Veterans Health Administration facility transmitted laboratory data to a central database; 76 799 (25%) had MHCs (based on diagnostic codes for depressed mood, anxiety, psychosis, manic symptoms, substance use disorders, personality disorders, and other categories). National data from Veterans Health Administration records, Medicare claims, and a national survey were linked to characterize 1999 diabetes care.


RESULTS
Failure to meet diabetes performance measures was more common in patients with MHCs: unadjusted odds ratio (95% confidence interval) was 1.24 (1.22-1.27) for no hemoglobin A(1c) testing, 1.25 (1.23-1.28) for no low-density lipoprotein cholesterol testing, 1.05 (1.03-1.07) for no eye examination, 1.32 (1.30-1.35) for poor glycemic control, and 1.17 (1.15-1.20) for poor lipemic control. Disparities persisted after case mix adjustment and were more pronounced with specific MHCs (psychotic, manic, substance use, and personality disorders). The percentage not meeting diabetes care standards increased with increasing number of MHCs.


CONCLUSIONS
Patients with mental illness merit special attention in national diabetes quality improvement efforts.
Frayne
Susan M
SM
Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
Halanych
Jewell H
JH
Miller
Donald R
DR
Wang
Fei
F
Lin
Hai
H
Pogach
Leonard
L
Sharkansky
Erica J
EJ
Keane
Terence M
TM
Skinner
Katherine M
KM
Rosen
Craig S
CS
Berlowitz
Dan R
DR
D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D019992:Databases as Topic; D048909:Diabetes Complications / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D044469:Racial Groups; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014728:Veterans
D006442:Glycated Hemoglobin