Diabetes, Dementia, and Disruptions in Health Care Use in 2020 for Low-Income Medicare Beneficiaries.

BACKGROUND

Despite widespread interruptions to health care in 2020, little evidence demonstrates how populations at highest risk for poor outcomes fared across a comprehensive scope of services.

METHODS

Among a predominantly low-income population of individuals ages 65 and older with diabetes (n = 4,187), we measured health care service use in Medicare and Medicaid claims data from 2018 to 2020. Stratified analyses included individuals with Alzheimer disease and related dementias (ADRD, n = 1,025), individuals who used Medicaid-funded home- and community-based services (HCBS, n = 264), and long-term nursing home services (n = 365).

RESULTS

Relative to 2018-2019, adjusted quarterly rates of evaluation and management visits dropped by 26% (95% confidence interval [CI]: 23%-28%) in Q2 2020 and remained 7% lower (95% CI: 4%-10%) in Q4 2020. Persistent declines occurred for inpatient discharges and emergency room visits (relative risk Q4 2020 vs. 2018-2019: 0.87 [95% CI: 0.76-0.99] and 0.77 [95% CI: 0.69-0.87], respectively). Insulin fills declined in later 2020 (relative risk Q4 2020 vs. 2018-2019: 0.87 [95% CI: 0.79-0.95]) while annual wellness visits rebounded (relative risk Q4 2020 vs. 2018-2019: 1.19 [95% CI: 1.06-1.34]). Individuals who used Medicaid-funded HCBS or long-term nursing home services before the pandemic had large declines in evaluation and management visits (relative risk Q4 2020 vs. 2018-2019: 0.80 [95% CI: 0.69-0.93] and 0.63 [95% CI: 0.43-0.94], respectively). Nursing home residents also had notable declines in insulin fills (relative risk Q4 2020 vs. 2018-2019: 0.73, 95% CI: 0.55-0.96). Individuals with ADRD had increased skilled nursing facility admissions (relative ratio Q3 2020 vs. 2018-2019 1.60, 95% CI: 1.21-2.13). Telehealth usage in 2020 did not differ based on ADRD diagnosis.

CONCLUSIONS

Extended disruptions in routine care highlight opportunities to improve support for older adults with diabetes.