Date of Conferral

2023

Degree

Ph.D.

School

Health Services

Advisor

Srikanta K. Banerjee

Abstract

Peripheral neuropathy (PN), a group of common heterogeneous disorders with varied etiologies, is associated with substantial morbidity and mortality. PN presents both as a diagnostic and therapeutic challenge to physicians and other healthcare providers. Socioeconomic moderators of PN in adults without diabetes in the United States have not been well studied. The consequences of PN can be devastating and include foot ulcers, amputations, a general decline in the quality of life, and death. The overall prevalence of PN in the United States is 13.5% in adults with diabetes and 11.6% in adults without diabetes. Clearly, these statistics indicate a public health burden. This current longitudinal study employed the socioecological model as the theoretical framework to examine whether poverty income ratio, veteran/military status, and health insurance status moderated the effect of PN on overall and cardiovascular mortality among adults without diabetes. The National Health and Nutrition Examination Survey (NHANES) 1999-2015 secondary dataset with linked-mortality data through December 31, 2015, resulting in a longitudinal dataset was analyzed using complex sample Cox regression analysis. Only poverty income ratio moderated the effect of PN on overall mortality; veteran/military status did not moderate the effect of PN on overall mortality, nor did health insurance status moderate the effect of PN on cardiovascular mortality. The results of this study have implications for positive social change. Policies that reduce poverty income ratio, such as those that reduce income inequality and help provide gainful employment, can improve the health outcomes of these adults not suffering from diabetes, but who have been diagnosed with PN in either foot.

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