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Table 5 Hazard ratios for antiglycemic intensification, and for the competing event, in the secondary model that examines the distinct contribution of each of the ten specific MHCs*

From: Mental illness and intensification of diabetes medications: an observational cohort study

 

0-14 days

15-30 days

31-180 days

Parameter†

HR

95% CI

HR

95% CI

HR

95% CI

MAIN ANALYSIS (Outcome: Intensification)

      

Depressive disorder (1 = yes, 0 = no)

1.01

0.99-1.09

1.21

1.08-1.36

1.12

1.04-1.21

PTSD

0.99

0.93-1.05

1.09

0.95-1.25

1.01

0.92-1.10

Anxiety disorder

1.01

0.92-1.11

0.89

0.71-1.12

1.10

0.97-1.26

Adjustment disorder

1.02

0.85-1.23

0.66

0.39-1.12

1.20

0.93-1.55

Psychotic disorder

0.92

0.84-1.01

1.01

0.83-1.25

1.06

0.94-1.20

Bipolar disorder

1.00

0.88-1.13

1.03

0.77-1.39

1.08

0.90-1.30

Substance use disorder

0.89

0.81-0.97

0.95

0.76-1.17

1.08

0.95-1.23

Personality/Impulse/Conduct disorder

0.88

0.71-1.10

1.17

0.75-1.84

0.86

0.63-1.18

Psychogenic disorder

1.27

0.95-1.69

0.88

0.39-1.97

1.79

1.21-2.64

Other MHC

1.15

0.86-1.53

1.49

0.80-2.79

1.03

0.64-1.64

Index HbA1c value 9–9.9‡

1.24

1.20-1.28

1.38

1.27-1.50

1.34

1.29-1.43

Index HbA1c value 10–10.9

1.32

1.26-1.38

1.29

1.15-1.45

1.49

1.40-1.59

Index HbA1c value 11–11.9

1.48

1.39-1.57

1.68

1.46-1.94

1.65

1.51-1.81

Index HbA1c value 12.0+

1.57

1.48-1.67

1.47

1.25-1.73

1.65

1.50-1.82

Sex (1 = male, 0 = female)

0.98

0.89-1.09

0.93

0.73-1.17

0.90

0.78-1.03

Log physical comorbidity index

1.00

0.97-1.04

1.03

0.96-1.11

1.24

1.18-1.30

Age (per 10 years)

0.95

0.94-0.96

0.95

0.92-0.99

0.93

0.91-0.95

Any macrovascular comorbidity

1.01

0.98-1.04

1.03

0.96-1.12

1.03

0.98-1.08

Any microvascular comorbidity

0.95

0.91-0.99

0.95

0.86-1.05

1.15

1.08-1.22

COMPETING EVENT (CE) ANALYSIS

(Outcome: HbA1c value <8.0)

      

Depressive disorder (CE) (1 = yes, 0 = no)

    

1.08

0.97-1.20

PTSD (CE)

    

1.01

0.89-1.14

Anxiety disorder (CE)

    

1.23

1.04-1.46

Adjustment disorder (CE)

    

1.39

0.99-1.94

Psychotic disorder (CE)

    

1.30

1.09-1.55

Bipolar disorder (CE)

    

1.20

0.93-1.55

Substance use disorder (CE)

    

0.98

0.80-1.20

Personality/Impulse/Conduct disorder (CE)

    

0.83

0.51-1.34

Psychogenic disorder (CE)

    

1.19

0.57-2.51

Other MHC (CE)

    

1.49

0.86-2.59

Index HbA1c value 9–9.9 (CE) ‡

    

0.56

0.51-0.60

Index HbA1c value 10–10.9 (CE)

    

0.31

0.27-0.36

Index HbA1c value 11–11.9 (CE)

    

0.28

0.22-0.35

Index HbA1c value 12.0+ (CE)

    

0.24

0.18-0.32

Sex (CE) (1 = male, 0 = female)

    

1.10

0.88-1.37

Log Physical Comorbidity Index (CE)

    

1.29

1.21-1.37

Age (per 10 years) (CE)

    

0.98

0.96-1.01

Any macrovascular comorbidity (CE)

    

0.95

0.89-1.01

Any microvascular comorbidity (CE)

    

1.11

1.02-1.20

  1. Legend: This table shows Hazard Ratios for intensification of antiglycemic medications in the 0–14, 15–30 and 31–180 days following HbA1c value ≥8.0, and for the competing event (HbA1c value <8.0) in the 31–180 days following HbA1c value ≥8.0. The model includes ten binary indicator variables for the ten most prevalent specific MHCs (depressive disorders, PTSD, other anxiety disorders, adjustment disorders, psychotic disorders, bipolar disorders, substance use disorders, personality or conduct/impulse control disorders, psychogenic disorders, and other MHCs) all in a single model.
  2. *Hazard Ratios (HR) with statistically significant p-values (at p < .05) are shown in bold face. Here “hazard rate” is the instantaneous rate of an event among those who have not experienced an event. The ratio of these rates under two different conditions is the “hazard ratio”.
  3. †In the 0–14 day and 15–30 day models, hospitalization, death, subsequent HbA1c value <8.0 and end of the specific interval without an event are treated as censoring variables. In the 31–180 day model, hospitalization, death and end of the interval without an event are treated as censoring variables, and subsequent HbA1c value <8.0 is treated as a competing event (with Hazard Ratios for the competing event shown in the lower half of the table). All analyses also control for the 125 VA facilities, through 124 individual dummy variables; the hazard ratios for each of those facilities are not shown in this table, for parsimony. The overall P-value for the facilities effect is <0.001 in each of the three time intervals.
  4. ‡Reference group for Index HbA1c value is HbA1c value of 8–8.9.
  5. Abbreviations: MHC, Mental Health Condition; PTSD, Posttraumatic stress disorder; HbA1c: Hemoglobin A1c; HR, Hazard Ratio; CI, Confidence Interval; CE, Competing Event analysis.
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BMC Health Services Research

ISSN: 1472-6963

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