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Urban–Rural Differences in Health Care Utilization and COVID-19 Outcomes in Patients With Type 2 Diabetes

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In general, utilization of the 4 tests measured fell considerably at the start of the pandemic (March 16, 2020), then rose through July 13, after which usage generally decreased through November 30.


Figure 1.

Nonseasonal autoregressive integrated moving average time-series models with linear splines at 4 dates in 2020 (March 16, May 4, July 13, and November 30) of weekly utilization rates per 1,000 patients with type 2 diabetes of hemoglobin A1c(HbA1c) tests (A), antihyperglycemic medication orders (B), emergency department visits (C), and outpatient or telehealth visits (D). All plots were stratified by administrative community type. The gray shading indicates the intervention period: March 16, 2020–December 31, 2020.

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In general, utilization of the 4 tests measured fell considerably at the start of the pandemic (March 16, 2020), then rose through July 13, after which usage generally decreased through November 30, except for antihyperglycemic medication orders (B), which increased between July 13 and November 30.


Figure 2.

Nonseasonal autoregressive integrated moving average time-series models with linear splines at 4 dates in 2020 (March 16, May 4, July 13, and November 30) of weekly utilization rates per 1,000 patients with type 2 diabetes of hemoglobin A1c(HbA1c) tests (A), antihyperglycemic medication orders (B), emergency department visits (C), and outpatient or telehealth visits (D). All plots were stratified by quartile of community socioeconomic deprivation (quartile 4 = most deprived). The gray shading indicates the intervention period: March 16, 2020–December 31, 2020.

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