Associations Between Healthcare Utilization Factors and Diabetic Retinopathy Among Adult African Americans

Associations Between Healthcare Utilization Factors and Diabetic Retinopathy Among Adult African Americans by Olusina Adesanya MPH, Walden University, 2015 MBBS, University of Lagos, 1983 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University November 2019 Abstract African Americans are disproportionately affected by diabetes mellitus (DM) and complications that include diabetic retinopathy and its disease and socioeconomic burdens. This study examined the relationships between diabetic retinopathy and health care utilization factors, such as gender, DM comorbidities of hypertension and hyperlipidemia, and health care access, among sampled African Americans with DM in the United States. The Andersen health care utilization model was the framework for the study. In this correlational cross-sectional study, data from the 2011-2016 National Health and Nutrition Examination Survey datasets were analyzed. Results of complex samples logistic regression showed that there were no significant associations between diabetic retinopathy and DM comorbidities of hypertension and hyperlipidemia, gender, and health care access, after controlling for hemoglobin A1C level, urine albumin-tocreatinine ratio (UACR), marital status, education level, and annual household income. UACR, annual household income, and adult education level were significantly associated with diabetic retinopathy (p <.005). Researchers might use findings from this study for further studies to establish cause-and-effect relationships between diabetic retinopathyAfrican Americans are disproportionately affected by diabetes mellitus (DM) and complications that include diabetic retinopathy and its disease and socioeconomic burdens. This study examined the relationships between diabetic retinopathy and health care utilization factors, such as gender, DM comorbidities of hypertension and hyperlipidemia, and health care access, among sampled African Americans with DM in the United States. The Andersen health care utilization model was the framework for the study. In this correlational cross-sectional study, data from the 2011-2016 National Health and Nutrition Examination Survey datasets were analyzed. Results of complex samples logistic regression showed that there were no significant associations between diabetic retinopathy and DM comorbidities of hypertension and hyperlipidemia, gender, and health care access, after controlling for hemoglobin A1C level, urine albumin-tocreatinine ratio (UACR), marital status, education level, and annual household income. UACR, annual household income, and adult education level were significantly associated with diabetic retinopathy (p <.005). Researchers might use findings from this study for further studies to establish cause-and-effect relationships between diabetic retinopathy and the related health utilization factors in this population. Positive social change might be effected by using results from the study in planning and developing effective public health interventions targeting specific African American populations, which might result in a reduction of the associated physical and socioeconomic burdens on these populations. Associations Between Health Care Utilization Factors and Diabetic Retinopathy Among Adult African Americans by Olusina Adesanya MPH, Walden University, 2015 MBBS, University of Lagos, 1983 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University November 2019 Dedication This study is dedicated to God all mighty for all his guidance and protection. This study is also dedicated to my parents, Pa. Ebenezer Olusanya Adesanya (deceased) and Ma. Dorcas Atoke Adesanya for instilling in my siblings and me the importance of pursuing quality higher education. I dedicate this study to my brother, Dr. Ayo-Oluwa Adesanya, for believing that I possess the ability, capability, capacity, and competence required for achieving this very important milestone in my life. I also thank you for your unprecedented support. My loving daughter, Folasade Olutayo Adesanya. This study is dedicated to you. I thank you for not giving up on me throughout this course, especially during the research period. Acknowledgments My sincere gratitude and appreciation go to my research committee chairperson, Dr. Shanna Barnett, and Dr. Mary Lou Gutierrez, my research committee member, for their guidance and uncompromising standards during this research. Through them, the definition of rigorous research was comprehended. To the university research reviewer, Dr. Jagdish Khubchandani, I thank you for your constructive appraisal, which has made me a better scholar. Dr. Jared Yogerst, my Student Success Advisor, I appreciate all your efforts at getting me registered for some Research Forum classes when I was forgotten by Walden University. To Charlette Martha Charles, my lifelong partner, your unwavering loving support provided the much-needed energy during a critical part of this research. I appreciate you more. Amanda Mitchel, I appreciate all your efforts that kept me focused during the study period.