Background

1. Diabetes Increases Financial Burden For Individuals with Spinal Cord Injury Clara E Dismuke, PhD, Leonard E Egede, MD MS, Lee Saunders PhD, James Krause, PhD Medical University of South Carolina & Ralph H. Johnson VAMC, Charleston, SC • Background • 8.3% of the American population andover 285 million adults worldwide live with type II diabetes. • Evidence exists of the association of diabetes with lower income. • Evidence also shows the association of spinal cord injury with lower income in the US with 18.33% of non-Hispanic White and 42.35% of Black families affected by SCI living below the poverty level. • However, the effect of diabetes on income of individuals with SCI is not yet known. • We hypothesized that diabetes will result in increasing the financial burden of an already impoverished group, individuals with SCI. • ? • Objective • To examine the association of diabetes with income among individuals with diabetes. • Methods • We performed a 15-year pooled analysis of a rolling cohort of 674 patients with SCI discharged from a major US rehabilitation facility. • Diabetes as well as other conditions (heart disease, angina, stroke, high blood pressure (BP), low BP, high cholesterol, cancer, anxiety and depression were self-reported as yes or no to the question “Have you ever been told you have…?” • Household income was self-reported in intervals such as [25,000-35,000] in 2010 dollars. • We examined the frequency of diabetes and 2010 income in this sample of individuals with SCI. • Due to income being provided in intervals instead of single dollar amounts, estimation via Ordinary Least Squares (OLS) or Generalized Linear Models (GLM) would be inappropriate. We used interval regression which takes into account both the lower and upper values of each interval to estimate the association of diabetes with household income among individuals with SCI, while adjusting for age, gender, education, and other clinical conditions. • We used STATA 11 for all analyses. Results • Diabetes was self-reported in 11.9% of individuals with SCI, a higher percentage than the 8.3% prevalence in the general American population. • 16.32% of households with individuals with SCI had an income lower than $10,000 in 2010. • 14.54% of households with individuals with SCI had an income between $10,000 and $15,000 in 2010. • 55.79% of households with individuals with SCI had an income less than $35,000 in 2010. • 66.47% of households with individuals with SCI had an income less than $50,000 (approximate median income for US population) in 2010. • In a fully adjusted interval model for age, gender, education, marital status and other clinical conditions, diabetes was significantly associated (P=0.04) with a loss of $8,991 (95% CI -$17,683:-297) relative to individuals with SCI and no diabetes. • The only other clinical condition significantly associated (P=0.01) with income loss was anxiety which was associated with a loss of $11,089 (95% CI -$19,812:-$2,366). Conclusions • Diabetes appears to be more frequent in individuals with SCI relative to the general American population. • Households affected by SCI have much lower incomes than the American population in absence of diabetes. • These findings appear to support our hypothesis that diabetes increases the financial burden to individuals with SCI and their families. • Efforts should be made to diagnose early and manage diabetes in individuals with SCI to reduce the further financial burden imposed by diabetes in this vulnerable population. • This study was supported by grant # H133G090059 (Krause) Dept of Education/NIDRR Ambulation and Secondary Complications: Participants with Chronic Spinal Cord Injury and a grant from the South Carolina Spinal Cord Injury Research Fund. 09-001. • Dismuke CE, Egede LE. Association between major depression, depressive symptoms and personal income in US adults with diabetes. 2010 General Hospital Psychiatry 32:484-491. • Dismuke CE, Krause JS, Terza JV. Racial Disparities in Poverty Status among Families of Individuals with Spinal Cord Injury.2011 Poverty&Public Policy 3:1-11. • http://www.ats.ucla.edu/stat/stata/output/Stata_Interval.htm • from Introduction to SAS. UCLA: Statistical Consulting Group. http://www.ats.ucla.edu/stat/sas/notes2/ (accessed August 28, 2013). • http://www.census.gov/prod/2012pubs/acsbr11-02.pdf Diabetes SCI Income