Advances in Preventive Medicine

Advances in Preventive Medicine / 2020 / Article

Research Article | Open Access

Volume 2020 |Article ID 4043959 | https://doi.org/10.1155/2020/4043959

America E. McGuffee, Kailyn Chillag, Amber Johnson, Regan Richardson, Hallie Williams, Jessica Hartos, "Effects of Routine Checkups and Chronic Conditions on Middle-Aged Patients with Diabetes", Advances in Preventive Medicine, vol. 2020, Article ID 4043959, 8 pages, 2020. https://doi.org/10.1155/2020/4043959

Effects of Routine Checkups and Chronic Conditions on Middle-Aged Patients with Diabetes

Academic Editor: Gerardo E. Guillén Nieto
Received18 Jun 2019
Accepted28 Aug 2019
Published26 Feb 2020

Abstract

Purpose. Middle-aged males and females with diabetes are more likely to have poor physical (PH) and mental health (MH); however, there is limited research determining the relationship between MH and PH and routine check-up in diabetic middle-aged adults, especially by gender. The purpose of this study was to determine whether PH and MH status differ by routine check-up in middle-aged (age 45–64) adults with diabetes in the general population. Methods. This cross-sectional analysis used data from the 2017 BRFSS conducted by the CDC for adults aged 45–64 who reported having diabetes in Florida (), Kentucky (), Maryland (), New York (), and Ohio (). Multiple logistic regression by state and gender was used to determine the relationship between MH and PH status and routine check-up while controlling for health-related, socioeconomic, and demographic factors. Results. Across states, up to one-half reported good PH (32–50%), over one-half reported good MH (46–67%), and most reported having a routine check-up (87–93%). Adjusted analysis indicated that MH and PH were not significantly related to routine check-up, but both were inversely related to having diabetes plus two other health conditions. Conclusions. Overall, routine check-up was not related to good PH and MH in this target population; however, a number of health conditions were inversely related to good PH and MH status. In a primary care setting for this target population, there may be a low to moderate prevalence of good PH and MH and a high prevalence of having a routine check-up and having multiple health conditions. It is recommended to automatically screen this target population for PH, MH, other chronic conditions, and physical activity and treat concurrently.

1. Introduction

Through utilization of preventative health examinations and routine checkups, the most common chronic physical and mental health conditions can be prevented, delayed, or treated more effectively [6, 11]. Visits of this type are linked with improved physical and mental health outcomes [4, 5, 14] as well as to improvements in health-related quality of life (HRQoL) and control over diseases [10]. However, research indicates that both engagement in preventative health checks and overall perception of one’s health differ based on demographic factors, socioeconomic status, health insurance coverage, lifestyle factors, and disease burden [4, 5, 9, 10, 1214].

Diabetes is a significant component of the disease burden in the US as it affects up to 30 million adults, and of those, up to 7 million may be undiagnosed (not aware of or did not report having DM) [2]. Because this condition is chronic and progressive, it can lead to other physical and mental health complications over time [10–12, 14] . In addition, those with diabetes report lower HRQoL ratings than do individuals without chronic illnesses [10]. Thus, annual or more frequent checkups would be necessary for persons with diabetes as research indicates that preventative care decreases both the prevalence and progression of this condition [6].

However, research for associations between routine checkups and physical or mental health tends to focus on older adults/Medicare users [46], with no studies assessing these relations for differences by gender [9, 12–14] or by diabetes status [4, 7, 8]. Therefore, the purpose of this study is to assess whether physical and mental health differ by receiving a routine checkup in middle-aged males and females with diabetes.

2. Methods

2.1. Design

This study is a cross-sectional analysis that used data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) conducted by the Centers for Disease Control and Prevention (CDC) [3]. BRFSS is an annual telephone survey system that uses random digit dialing techniques for both landlines and cell phones across all 50 states in the US and the District of Columbia. This survey gathers data about US adult residents’ health-related behaviors, chronic health conditions, and use of preventative services. The CDC compiles all BRFSS data and makes deidentified data available for secondary analysis by researchers. This study was given exempt status by the Institutional Review Board of The University of North Texas Health Science Center.

2.2. Sample

The samples in the study include males and females with diabetes between the ages of 45 and 64 in Florida (), Kentucky (), Maryland (), New York (), and Ohio () that had data for mental health, physical health, and routine checkup. These states were chosen because they had a large diabetic population and higher rates of fair/poor health status when compared to the other states [1].

2.3. Data

The original BRFSS variables for mental and physical health were determined by asking participants to self-report the number of “poor health days” in the past 30 days separately for mental health and physical health. Because these responses were highly skewed toward 0 days in each state and because we wanted to predict “good” health, we reversed and dichotomized these values to represent “yes” (30 days of good health in the past 30 days) or “no” (fewer than 30 days of good health in the past 30 days) separately for “good mental health” and “good physical health.” The factor of interest, routine check-up, was measured as yes/no to having a checkup in the past year.

All models controlled for physical activity, weight status, tobacco use, alcohol use, education level, income level, employment status, age, ethnicity/race, and marital status. Health conditions were measured as the number of “yes” responses to whether participants had any of the following: heart attack, coronary heart disease, stroke, asthma, skin cancer, cancer, COPD, arthritis, depression, kidney disease, and diabetes. The resulting numbers were then categorized as “diabetes only,” “diabetes plus one other chronic condition,” and “diabetes plus two other chronic conditions.” Alcohol use was measured in BRFSS as number of drinks per day and we categorized the numbers as “none,” “light” (<1), and “moderate or excessive” (1–4+ females, 1–5+ males). All variables and their categories are shown in Table 1(a).

2.4. Analysis

Frequency distributions by state were used to describe the samples. Multiple logistic regression was conducted by state and gender to determine the relationship between mental and physical health status and routine check-up while controlling for health-related, socioeconomic, and demographic factors. The state and gender data were analyzed separately to determine the relationship between the variables across multiple similar samples within our population of interest. As such, similar results in three out of five states were considered reliable evidence for relations. Any observations with missing data for any variable were excluded from the adjusted analysis and all analyses were conducted in STATA Version 15.1 (Copyright 1985–2017 StataCorp LLC).

3. Results

3.1. Participant Characteristics: Males with Diabetes

Table 1(b) lists participant characteristics for middle-aged males with diabetes. The majority of participants had attended a routine medical checkup within the past year (87–90%) and reported good mental health (56–67%), but less than half reported good physical health (37–50%). Regarding health conditions, most participants had diabetes plus two or more chronic illnesses (71–84%) and were obese (54–63%), yet less than half reported being inactive (33–47%). Regarding health behaviors, one-third to one-half of participants did not use tobacco products (34–55%) or alcohol (47–69%). For demographics, the majority of participants were married (48–60%) and reported their race as white (56–87%). As for socioeconomic status, the majority of respondents had not graduated from college or technical school (67–77%), approximately half were employed (40–59%), and up to two-thirds earned an income of $50,000 or more (40–69%).

(a) Participant characteristics by state: diabetic males.

VariableFlorida ()Kentucky ()Maryland ()New York ()Ohio ()
%%%%%

Good mental health516100236100311100300100323100
Yes3336513156207671996620965
No1833510544104331013411435
Good physical health516100236100311100300100323100
Yes232458737154501414714244
No2845514963157501595318156
Routine checkup516100236100311100300100323100
Yes4518721390280902688929290
No65132310311032113110
Health conditions4759221892296952869530293
0 or 1 other health condition101213416672384295518
2 other health conditions3747918484229772027124782
Physical activity4618921491270872488330093
Inactive19542101479033953812642
Insufficiently active90204822602252216221
Active/Highly active176386530120441014111237
Weight status4879423097295952879631598
Underweight or normal53112712341232113411
Overweight149316428832899348326
Obese2855913960178601565419863
Tobacco use4959622997296952779231598
Never221457834149501515515449
Former1823782369030853111336
Current92196930571941154815
Alcohol use4959622897298962939831397
None2996015769146491384718258
Light57122712421446164213
Moderate or excessive13928441911037109378928
Age516100236100311100300100323100
45–5417634763210734103348326
55–643406616068204661976624074
Ethnicity/Race5069823499304982889631397
White3286518679191631625627287
Other17835482111337126444113
Marital status511992359931010029910032199
Married2925713055187601454819059
Not married2194310545123401545213141
Education level515100233993101002979932199
Graduated college1262556242093393317523
Did not graduate college3897617776101672046924677
Income level4649018277272872729128789
$50,000 or more142316536164601033812343
Less than $50,0003226911764108401696216457
Employment status5129923599309992919732299
Employed217429440181591475115448
Other2955814160128411444915852

(b) Participant characteristics by state: females with diabetes.

VariableFlorida ()Kentucky ()Maryland ()New York ()Ohio ()
%%%%%

Good mental health667100381100420100293100431100
Yes3315019752232551344620548
No3365018448188451595422652
Good physical health667100381100420100293100431100
Yes258391233219346963316238
No4096125868227541976726962
Routine checkup667100381100420100293100431100
Yes5808735393372892679139191
No87132874811269409
Health conditions6059135590398952749439592
0 or 1 other health condition115195114782052196216
2 other health conditions4908130486320802228133384
Physical activity6109134490365872508540193
Inactive2944818955150411074319849
Insufficiently active116198722174205228321
Active/Highly active20033832414139883512030
Weight status5898833588378902709238890
Underweight or normal911544134343114115318
Overweight147259227902473279424
Obese3516019959245651565826368
Tobacco use6439637598398952759442298
Never3255118048232581435221150
Former166261082910526782811126
Current15224$87236115542010024
Alcohol use6569837999410982849742097
None4737230380227551436030773
Light6810359^852178146415
Moderate or excessive115184111982454264912
Age667100381100420100293100431100
45–542343514037140331204113431
55–644336524163280671735929769
Ethnicity/Race6519837799416992799542799
White4266530982230551625834882
Other22535681818644117427919
Marital status666100379994179928898429100
Married3004519652200481184120548
Not married3665518348217521705922452
Education level66710038010042010029199429100
Graduated college1372183221423492329522
Did not graduate college5307929778278661996833478
Income level5448226870357852568637286
$50,000 or more13024943517950863411731
Less than $50,0004147617465178501706625569
Employment status662993799941810028798430100
Employed2353613335213511284516438
Other4276524665205491595526662

3.2. Participant Characteristics: Females with Diabetes

Table 1(a) lists participant characteristics for middle-aged females with diabetes. Most participants reported having a routine checkup within the past year (87–93%). About half of the participants reported good mental health (46–55%) and less than half reported good physical health (32–46%). Regarding health conditions, most participants had diabetes plus two or more chronic conditions (80–86%) and were obese (58–68%), and about one-third to one-half reported being inactive (41–55%). Regarding health behaviors, the majority of participants reported no tobacco (48–58%) or alcohol use (55–80%). For demographics, a range of participants reported their race as white (55–82%) and around one half were married (41–52%). As for socioeconomic status, the majority of respondents had not graduated from college or technical school (66–79%) and earned an income of less than $50,000 (50–76%), while one-third to one-half of participants were employed (35–51%).

3.3. Mental Health: Males

As shown in Table 2(a), the results of multiple logistic regression analysis for middle-aged males with diabetes indicated that after controlling for all other variables in the model, good mental health was significantly related to having had routine checkups in only 1 out of 5 states, which was not considered a reliable finding across states as was defined in the methods section.

(a) Results of multiple logistic regression analyses across states: males.

Predicting good mental health (yes vs. no)FloridaKentuckyMarylandNew YorkOhio
AOR95% CIAOR95% CIAOR95% CIAOR95% CIAOR95% CI
LowHighLowHighLowHighLowHighLowHigh

Routine check-up
NoRefRefRefRefref
Yes1.270.642.504.431.0718.452.060.735.822.020.685.980.950.352.61
Health conditions
0 or 1 other health conditionRefRefRefRefRef
2 other health conditions0.240.100.541.040.254.250.510.201.280.230.920.550.780 .331.84
Predicting good physical health (yes vs. no)FloridaKentuckyMarylandNew YorkOhio
AOR95% CIAOR95% CIAOR95% CIAOR95% CIAOR95% CI
LowHighLowHighLowHighLowHighLowHigh
Routine check-up
NoRefRefRefRefref
Yes0.590.291.182.390.5310.771.390.503.862.550.847.761.480.544.03
Health conditions
0 or 1 other health conditionRefRefRefRefRef
2 other health conditions0.180.090.370.080.010.480.410.180.960.390.180.880.950.422.11

Note. AOR = adjusted odds ratio; 95% CI = 95% confidence intervals; Ref = referent group; boldface indicates significance (AORs with 95% CI that do not include 1.00 are significant). All models controlled for physical activity, weight status, tobacco use, alcohol use, age, ethnicity/race, marital status, education level, income level and employment status.
(b) Results of multiple logistic regression analyses across states: females.

Predicting good mental health (yes vs. no)FloridaKentuckyMarylandNew YorkOhio
AOR95% CIAOR95% CIAOR95% CIAOR95% CIAOR95% CI
LowHighLowHighLowHighLowHighLowHigh

Routine check-up
Norefrefrefrefref
Yes1.390.712.731.050.313.610.560.221.414.581.2416.910.850.342.10
Health conditions
0 or 1 other health conditionrefrefrefrefref
2 other health conditions0.270.140.520.260.090.760.350.160.770.510.211.290.300.130.67
Predicting good physical health (yes vs. no)FloridaKentuckyMarylandNew YorkOhio
AOR95% CIAOR95% CIAOR95% CIAOR95% CIAOR95% CI
LowHighLowHighLowHighLowHighLowHigh
Routine check-up
Norefrefrefrefref
Yes1.360.652.872.160.558.490.770.331.800.540.171.711.060.402.77
Health conditions
0 or 1 other health conditionrefrefrefrefref
2 other health conditions0.330.180.610.110.040.330.590.301.170.140.050.390.350.160.78

Note. AOR = adjusted odds ratio; 95% CI = 95% confidence intervals; Ref = referent group; boldface indicates significance (AORs with 95% CI that do not include 1.00 are significant).
3.4. Physical Health: Males

Also shown in Table 2(a), the results of multiple logistic regression analysis for middle-aged males with diabetes indicated that after controlling for all other variables in the model, good physical health was not significantly related to routine checkups across in any state. However, those who reported having diabetes plus two or more other chronic conditions were about 2.5–12.5 times less likely to report good physical health compared to those who reported diabetes only across states.

3.5. Mental Health: Females

As shown in Table 2(b), the results of multiple logistic regression analysis for middle-aged females with diabetes indicated that after controlling for all other variables in the model, good mental health was significantly related to having routine checkups in only 1 out of the 5 states, which was not considered a reliable finding across similar samples. However, compared to those with only diabetes, those who reported having diabetes plus two or more other chronic conditions were approximately three to four times less likely to report good mental health compared to those who reported having diabetes only in a majority of the states.

3.6. Physical Health: Females

Also shown in Table 2(b), the results of multiple logistic regression analysis for middle-aged females with diabetes indicated that after controlling for all other variables in the model, good physical health was not significantly related to routine checkup across states. However, those who reported having diabetes plus two or more other chronic conditions were about 3–9 times less likely to report good physical health compared to those who reported having diabetes only in the majority of the states.

4. Discussion

The purpose of this study was to determine whether physical and mental health status differ by routine checkup in middle-aged males and females with diabetes. For this target population, both good mental and physical health did not significantly differ related to having routine checkups across states. These results differ from prior research which showed that preventative care is related to both improved depressive symptoms and the perception of good overall health [4, 5, 11]. The differences in findings may be due to differing target populations. While our results focus on patients with diabetes, previous research focused on the general population as a whole. Therefore, it is possible that prevention efforts were in place as most of the patients were already under medical care. Thus, to our knowledge, our study is the first to focus only on middle-aged patients with diabetes as related to regular checkups.

However, the results of this study did show that for middle-aged males and females with diabetes, good physical and mental health were inversely related to having diabetes plus two or more other health conditions. This is generally consistent with prior research that showed chronic illnesses to be related to lower overall health in the general population [12]. As prior research focused primarily on the general population, our study focuses solely on middle-aged people with diabetes. For this target population, the comanagement and treatment of multiple chronic conditions may have a significant impact on their mental and physical health, and the assessment of comorbid conditions should be a focus for their care.

4.1. Limitations

The use of BRFFS data provided large, multiple samples to evaluate both physical and mental health (instead of “general” health) and separately for males and females (instead of together), which allowed us to determine whether patterns in variable relations were similar for different facets of health and by gender. In addition, BRFSS also provided current information, given that our dependent variables (mental and physical health) were measured within the last 30 days. However, BRFSS did not include variables that provided information about (1) current treatment and management of any mental or physical health condition, (2) current treatment and management of diabetes specifically, or (3) current management and severity of the chronic illnesses in addition to diabetes, all of which could have an impact upon mental and physical health. Future studies should include information about the current management and treatment of any mental and physical health conditions and should consider the influence of specific disease management and medication use in relation to its impact on mental and physical health in diabetics.

5. Conclusions

Because this study used population-based data, the results may generalize to males and females aged 45–64 with diabetes. Regarding the optimization of patient’s mental and physical health, we recommend automatic mental and physical health screening for adults aged 45–64 with diabetes as well as screening for other chronic health conditions. General practitioners should assess comorbid conditions and treatments, refer to specialists as needed, and educate patients on the importance of proper management of diabetes in combination with any other chronic illnesses for maintaining good mental and physical health.

Data Availability

BRFSS 2017 data is available online from the CDC at https://www.cdc.gov/brfss/annual_data/annual_2017.html.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References

  1. Center for Disease Control and Prevention (CDC), “BRFSS prevalence and trends data,” 2017a, https://www.cdc.gov/brfss/brfssprevalence/index.html. View at: Google Scholar
  2. Centers for Disease Control and Prevention (CDC), “National diabetes statistics report,” 2017b, https://www.cdc.gov/diabetes/data/statistics/statistics-report.html. View at: Google Scholar
  3. Center for Disease Control and Prevention (CDC), “Behavioral risk factor surveillance system,” 2018, https://www.cdc.gov/brfss/index.html. View at: Google Scholar
  4. D. Culica, J. Rohrer, M. Ward, P. Hilsenrath, and P. Pomrehn, “Medical checkups: who does not get them?” American Journal of Public Health, vol. 92, no. 1, pp. 88–91, 2002. View at: Publisher Site | Google Scholar
  5. R. Dryden, B. Williams, C. McCowan, and M. Themessl-Huber, “What do we know about who does and does not attend general health checks? Findings from a narrative scoping review,” BMC Public Health, vol. 12, no. 723, pp. 1–23, 2012, http://www.biomedcentral.com/1471-2458/12/723. View at: Google Scholar
  6. H. Eyre, R. Kahn, and R. M. Robertson, “Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American cancer society, the American diabetes association, and the American Heart Association,” Diabetes Care, vol. 27, no. 7, pp. 1812–1824, 2004. View at: Publisher Site | Google Scholar
  7. I. Ganguli, J. Souza, and J. McWilliams, “Trends in use of the U.S. Medicare annual wellness visit, 2011–2014,” Journal of American Medical Association, vol. 317, no. 21, pp. 2233–2235, 2017. View at: Publisher Site | Google Scholar
  8. A. Mehrota, A. M. Zaslavsky, and J. Z. Ayanian, “Preventative health examinations and preventative gynecological examinations in the United States,” Archives of Internal Medicine, vol. 167, no. 17, pp. 1876–1883, 2007. View at: Publisher Site | Google Scholar
  9. A. Molarius, K. Berglund, C. Eriksson et al., “Socioeconomic conditions, lifestyle factors, and self-rated health among men and women in Sweden,” European Journal of Public Health, vol. 17, no. 2, pp. 125–133, 2006. View at: Publisher Site | Google Scholar
  10. R. R. Rubin and M. Peyrot, “Quality of life and diabetes,” Diabetes and Metabolism Research and Reviews, vol. 15, no. 3, pp. 205–218, 1999, https://www.ncbi.nlm.nih.gov/pubmed/10441043. View at: Google Scholar
  11. A. L. Siu, K. Bibbins-Domingo, D. C. Grossman et al., “Screening for depression in adults,” JAMA, vol. 315, no. 4, pp. 380–387, 2016. View at: Publisher Site | Google Scholar
  12. T. W. Strine, D. P. Chapman, L. S. Balluz, D. G. Moriarty, and A. H. Mokdad, “The associations between life satisfaction and health-related quality of life, chronic illness, and health behaviors among U.S. community-dwelling adults,” Journal of Community Health, vol. 33, no. 1, pp. 40–50, 2008. View at: Publisher Site | Google Scholar
  13. M. Tajvar, M. Arab, and A. Montazeri, “Determinants of health-related quality of life in elderly Tehran Iran,” BMC Public Health, vol. 8, no. 323, 2008. View at: Publisher Site | Google Scholar
  14. P. E. Wandell, “Quality of life of patients with diabetes mellitus,” Scandinavian Journal of Primary Health Care, vol. 23, no. 2, pp. 68–74, 2005. View at: Publisher Site | Google Scholar

Copyright © 2020 America E. McGuffee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


More related articles

 PDF Download Citation Citation
 Download other formatsMore
 Order printed copiesOrder
Views189
Downloads352
Citations

Related articles