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Sex Differences in Diabetes Prevalence, Comorbidities, and Healthcare Utilization Among American Indians Living in the Northern Plains

Kimberly R Huyser, Jennifer Rockell, Valarie Blue Bird Jernigan, Tori Taniguchi, Charlton Wilson, Spero M Manson, Joan O'connell
Current Developments in Nutrition ; doi:10.1093/cdn/nzz089

Abstract: Background The American Indian (AI) population experiences significant diet-related health disparities including diabetes and cardiovascular disease. Due to the relatively small sample size of AIs, the population is rarely included in large national surveys such as the National Health and Nutrition Examination Survey. This exclusion hinders efforts to characterize potentially important differences between AI men and women, track the costs of these disparities, and effectively treat and prevent these conditions. Objective We examine the sex differences in diabetes prevalence, comorbidity experience, healthcare utilization, and treatment costs among AIs within a Northern Plains Indian Health Service (IHS) service unit. Methods We assessed data from a sample of 11,144 persons using an IHS service unit in the Northern Plains region of the United States. Detailed analyses were conducted for adults (n = 7,299) of prevalence of diabetes by age and sex. We described sex differences in comorbidities, healthcare utilization, and treatment costs among the adults with diabetes. Results In our sample, adult males and females had a similar prevalence of diabetes (10.0% and 11.0%, respectively). The prevalence of cardiovascular disease among males and females with diabetes was 45.7% and 34.0% respectively. Among adults with diabetes, males had statistically higher prevalence of hypertension and substance use disorders compared to females. The males were statistically less likely to have a non-substance use mental health disorder. Although males had higher utilization and costs for hospital inpatient services than females, the differences were not statistically significant. Conclusions In this AI population, there were differences in comorbidity profiles between adult men and women with diabetes, which have differential mortality and cost consequences. Appropriate diabetes management addressing gender-specific comorbidities, such as substance use disorders for men and non-substance use mental health disorders for women, may help reduce additional comorbidities or complications to diabetes.
Keywords: prevalence / adults / Cardiovascular disease / Males / men and women / Differences in Diabetes / differences in comorbidities

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