The Impact of Hypothyroidism on Cardiovascular-Related Healthcare Utilization in the US Population With Diabetes

Context: Suboptimal treatment of hypothyroidism (HT) is associated with adverse cardiovascular disease (CVD) outcomes, for which patients with diabetes mellitus (DM) are at increased risk.

Objective: This study aimed to compare CVD-related healthcare utilization in DM patients with and without HT in the US population.

Methods: Participant data were collected from the Medical Expenditure Panel Survey (MEPS) over 10 years (2011-2020). Medical conditions were identified by ICD-9/ICD-10 codes associated with expenditures. Healthcare utilization outcomes included number of emergency, hospital, and outpatient visits associated with coronary artery disease (CAD), stroke/transient ischemic attack (TIA), or heart failure; prescriptions related to CVD; and number of visits to specialty providers. A propensity score-based fine stratification matching approach was used to balance sociodemographic covariates to determine the relative risk (RR) contributed by HT on CVD-related care utilization.

Results: A total of 15 580 adult participants with DM were identified, of whom 11.9% had treated HT. In the weighted analysis, a significantly greater proportion of participants with HT had CAD and stroke/TIA-associated visits compared to those without HT (respectively, 22.4% vs 17.8%, P = .002; and 7.3% vs 5.4%, P = .020). In the matched analysis, participants with HT were more likely to see a specialist (cardiology, endocrinology, and nephrology). Participants with HT were more likely to be treated with cholesterol-lowering medications, beta-blockers, and diuretics.

Conclusion: HT as a comorbidity with DM was associated with increased healthcare utilization related to CVD, specifically visits associated with stroke/TIA, increased use of specialty care, and greater utilization of CVD-related medications.