Phenotyping healthcare use 2-3 decades before the first multiple sclerosis demyelinating event
Tremlett H, Everett K, Maxwell CJ, Zhu F, Asaf A, Li P, McKay KA, Zhao Y, Marrie RA. Ann Clin Transl Neurol. 2025 Jun 12 [Epub ahead of print].
Aims — To compare processes of diabetes care by homeless status.
Methods — A population-based propensity matched cohort study was conducted in Ontario, Canada. People with diabetes were identified in administrative healthcare data between April 2006 and March 2019. Those with a documented history of homelessness were matched to non-homeless controls. Data on processes of care measures included glucose monitoring tests, screening for microvascular complications, and physician follow-up. Differences in processes of care were compared by homeless status using proportions, risk ratios, and rate ratios.
Results — Of the 1,076,437 people with diabetes, 5219 matched pairs were identified. Homelessness was associated with fewer tests for glycated hemoglobin (RR = 0.63; 95 %CI: 0.60-0.67), LDL cholesterol (RR = 0.80; 95 %CI: 0.78-0.82), serum creatinine (RR = 0.94; 95 %CI: 0.92-0.97), urine protein quantification (RR = 0.62; 95 %CI: 0.59-0.66), and eye examinations (RR = 0.74; 95 %CI: 0.71-0.77). People with a history of homelessness were less likely to use primary care for diabetes management (RR = 0.62; 95 %CI: 0.59-0.66) or specialist care (RR = 0.87; 95 %CI: 0.83-0.91) compared to non-homeless controls.
Conclusions — Disparities in diabetes care are evident for people with a history of homelessness and contribute to excess morbidity in this population. These data provide an impetus for investment in tailored interventions to improve healthcare equity and prevent long-term complications.
Wiens K, Bai L, Hwang SW, Ronksley PE, Austin PC, Booth GL, Spackman E, Campbell DJT. Diabetes Res Clin Pract. 2024; 213:111748. Epub 2024 Jun 15.
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