Introduction and Objective: Access to primary care and social determinants of health (SDOH) both impact diabetes care. We aimed to determine whether primary care (assessed as primary care physician [PCP] supply) modifies the association between SDOH and measures of diabetes care among Medicare beneficiaries.Methods: We used 2022 county data on PCP supply from the Area Health Resources Files and diabetes outcomes (screening, Prevention Quality Indicators, hospitalization and emergency visits) from the CMS Mapping Medicare Disparities tool. Associations were estimated using negative binomial models with state fixed effects, adjusting for sex, physical activity, smoking, food environment, and rurality. Interactions were tested using Wald chi-square tests with state-clustered standard errors. We plotted mean adjusted rates by social vulnerability index (SVI) and PCP.Results: Among 3081 U.S. counties, those in the lowest PCP supply quartile were more rural, had fewer women, older populations, and worse health profiles. Significant PCP supply × SVI interactions were observed for diabetes screening (p=0.01), long-term complications (p=0.03), lower limb amputations (p<0.01), and diabetes hospitalizations (p<0.01). Lowest PCP had the steepest gradients in diabetes outcomes across SVI.Conclusion: While increasing PCP supply dampened the adverse effect of greater SVI on diabetes outcomes, it may be insufficient without concurrent social interventions.
O. Iyalomhe: None. K.S. Robinson-Ector: None. S.J. Huang: None. R. McCoy: None.
American Diabetes Association (11-22-ICTSHD-11), National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK098107-09)
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