supplementary material · full models for material need insecurities and diabetes mellitus control...

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Supplementary Material Berkowitz SA, Meigs JB, DeWalt D, et al. Material need insecurities, control of diabetes mellitus, and use of health care resources: results of the Measuring Economic Insecurity in Diabetes Study. JAMA Intern Med. Published online December 29, 2014. doi:10.1001/jamainternmed.2014.6888.

eAppendix. Material Need Insecurities Instruments

eTable 1. Cross-tabulations of Material Need Insecurities

eTable 2. Full Models for Material Need Insecurities and Diabetes Mellitus Control Analyses

eTable 3. Full Model for Number of Material Need Insecurities and Diabetes Mellitus Control Analysis

eTable 4. Full Models for Material Need Insecurities and Outpatient Visits Analyses

eTable 5. Full Model for Number of Material Need Insecurities and Outpatient Visits Analysis

eTable 6. Full Models for Material Need Insecurities and Emergency Department/Inpatient Visits Analyses

eTable 7. Full Model for Number of Material Need Insecurities and Emergency Department/Inpatient Visits Analysis

eTable 8. Full Models for Material Need Insecurities and Hemoglobin A1c Level >9.0% Analyses

eTable 9. Full Models for Material Need Insecurities and LDL Cholesterol Level >100 mg/dL Analyses

eTable 10. Full Models for Material Need Insecurities and Blood Pressure >140/90 mm Hg Analyses

eTable 11. Full Model for All 4 Material Need Insecurities and Diabetes Mellitus Control Analysis

eTable 12. Full Model for All 4 Material Need Insecurities and Outpatient Visits Analysis

eTable 13. Full Model for All 4 Material Need Insecurities and Emergency Department/Inpatient Visits Analysis

eTable 14. Full Model for All 4 Material Need Insecurities and Hemoglobin A1c Level >9.0% Analysis

eTable 15. Full Model for All 4 Material Need Insecurities and LDL Cholesterol Level >100 mg/dL Analysis

eTable 16. Full Model for All 4 Material Need Insecurities and Blood Pressure >140/90 mm Hg Analysis This supplementary material has been provided by the authors to give readers additional information about their work.

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eAppendix. Material Need Insecurities Instruments

Experiences with Prescription Medications

The following questions concern the use of prescription medication RX1. DURING THE PAST 12 MONTHS, was there any time when you needed prescription medicines but didn't get it because you couldn't afford it?

1. Yes 2. No 99. Don’t Know or Refused

DURING THE PAST 12 MONTHS, are any of the following true for you? RX2 .…You skipped medication doses to save money


RX3 .…You took less medicine to save money


RX4 .…You delayed filling a prescription to save money


Scoring: a ‘Yes” response to any item was scored as reporting cost-related medication underuse



Experiences with Food

These next questions are about the food eaten in your household in the last 12 months, since {current month} of last year and whether you were able to afford the food you need. FS1. I’m going to read you several statements that people have made about their food

situation. For these statements, please tell me whether the statement was often true, sometimes true, or never true for {you/your household} in the last 12 months—that is, since last {name of current month}.

The first statement is, “The food that {I/we} bought just didn’t last, and {I/we} didn’t have money to get more.” Was that often, sometimes, or never true for {you/your household} in the last 12 months?

1. Often true 2. Sometimes true 3. Never true 99. Don’t Know or Refused

FS2. “{I/we} couldn’t afford to eat balanced meals.” Was that often, sometimes, or never true

for {you/your household} in the last 12 months?

1. Often true 2. Sometimes true 3. Never true 99. Don’t Know or Refused

FS3. In the last 12 months, since last {name of current month}, did {you/you or other adults in your household} ever cut the size of your meals or skip meals because there wasn't enough money for food?

1. Yes 2. No (Skip FS4) 99. Don’t Know or Refused (Skip FS4)

FS4. [IF YES ABOVE, ASK] How often did this happen—almost every month, some months

but not every month, or in only 1 or 2 months?

1. Almost every month 2. Some months but not every month 3. Only 1 or 2 months 77. Question Skipped 99. Don’t Know or Refused



FS5. In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money for food?


FS6. In the last 12 months, were you ever hungry but didn't eat because there wasn't enough

money for food?


Scoring: For items 1, and 2 a response of ‘often’ or ‘sometimes’ is coded as affirmative. For items 3, 5, and 6, a response of ‘yes’ is coded as affirmative. For item 4, a response of ‘almost every month’ or ‘some months but not every month’ is coded as affirmative. Two or more affirmative responses are coded as ‘reports food insecurity’.



Experiences with Housing

These next questions are about your housing. HS1. Do you live in….?

1. An apartment 2. A house/townhouse/condo 3. A shelter/transitional living situation [Skip to HS3] 4. Other ____________ 5. Residential treatment/supervised housing 6. Government housing (army, etc.) 7. Mobile home/trailer 8. Room/rented room [Skip to HS3] 9. Car [Skip to HS3] 10. No steady place to sleep at night [Skip to HS3] 11. Hotel/motel [Skip to HS3] 99. Don’t Know or Refused

HS2. Do you own your own home? [PROMPT: Is the house under your name? OR Could you sell the home if you/s/he wanted to?]


HS3. In the past three years, how many places, including your current place, have you lived for one week or longer?

_ _ [RECORD NUMBER. IF >50, RECORD 50]

[IF ANSWER IS 01, SKIP TO ITEM HS5]

99. Don’t Know or Refused HS4. Did you move because you could no longer afford that home?


HS5. Have you moved in with anyone in the last 12 months to share household expenses?




HS6. Have you ever been homeless at any time in the last 12 months?


Scoring: For item 1, a response of ‘3’, ‘9’ or ‘10’ was scored as reporting unstable housing. For item 3, a response > 10 was scored as reporting unstable housing. For items 4, 5, or 6, a ‘yes’ response was scored as reporting unstable housing.



Experiences with Energy and Utilities

This section asks about your energy expenses and utilities. IF LIVING IN SHELTER OR OTHER TYPE OF INSTITUTION, SKIP EI1. In the past year did your home receive energy assistance?


EI2. Since {name of current month} of last year has the gas or electric company sent you a letter threatening to shut off the gas or electricity in the house for not paying bills?


EI3. Since {name of current month} of last year has the gas, electric, or oil company shut off or refused to deliver gas, electricity, or oil for not paying bills?


EI4. Since {name of current month}of last year were there any days that the home was not heated or cooled because you couldn’t pay the bills?


EI5. Since {name of current month}of last year have you ever used a cooking stove to heat the house or apartment because you couldn’t pay the bills? [Not including a time the stove was used for heat during a power outage]


Scoring: A response of ‘Yes’ to any item was scored as reporting energy insecurity



References

1. Berkowitz SA, Seligman HK, Choudhry NK. Treat or Eat: Food insecurity, cost-related medication underuse and unmet needs. Am J Med. Jan 16 2014.

2. Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to Measuring Household Food

Security, Revised 2000. In: U.S. Department of Agriculture Food and Nutrition Service, ed. Alexandria VA. 2000

3. Children's HealthWatch. Children's HealthWatch Interview. 2013;

http://www.childrenshealthwatch.org/methods/our-survey/. Accessed 30 April 2014.

4. Cook JT, Frank DA, Casey PH, et al. A brief indicator of household energy security: associations with food security, child health, and child development in US infants and toddlers. Pediatrics. Oct 2008;122(4):e867-875.

5. Kushel MB, Gupta R, Gee L, Haas JS. Housing instability and food insecurity as barriers to health care among low-income Americans. J Gen Intern Med. 2006 Jan;21(1):71-7.

6. Vijayaraghavan M, Jacobs EA, Seligman H, Fernandez A. The association between housing instability, food insecurity, and diabetes self-efficacy in low-income adults. J Health Care Poor Underserved. Nov 2011;22(4):1279-1291.

7. Burgard SA, Seefeldt KS, Zelner S. Housing instability and health: findings from the

Michigan Recession and Recovery Study. Soc Sci Med. 2012. Dec;75(12):2215-24. 8. Economic Research Service. U.S. Household Food Security Survey Module: Six-Item

Short Form. USDA; 2012 [25 Aug 2014]; Available from: http://www.ers.usda.gov/datafiles/Food_Security_in_the_United_States/Food_Security_Survey_Modules/short2012.pdf.

9. Vijayaraghavan M, Kushel MB, Vittinghoff E, Kertesz S, Jacobs D, Lewis CE, Sidney S,

Bibbins-Domingo K. Housing instability and incident hypertension in the CARDIA cohort. J Urban Health. 2013 Jun;90(3):427-41.



eTable 1. Cross-tabulations of Material Need Insecurities A. Food insecurity and cost-related medication underuse N (%) + CRMU - CRMU Total + Food Insecurity 52 (12.9)

28 (7.0)

80 (19.9)

- Food Insecurity 50 (12.4)

273 (67.7)

323 (80.2)

Total 102 (25.3)

301 (74.7)

403 (100.0)

B. Food insecurity and housing instability N (%) + Housing instability - Housing instability Total + Food Insecurity 27 (6.6)

53 (13.0) 80 (19.7)


311 (76.4) 327 (80.3)

Total 43 (10.6)

364 (89.4) 407 (100.0)

C. Food insecurity and energy insecurity N (%) + Energy insecurity - Energy insecurity Total + Food Insecurity 34 (8.4)

46 (11.3) 80 (19.7)


289 (71.0) 327 (80.3)

Total 72 (17.7)

335 (82.3) 407 (100.0)



D. Cost-related medication underuse and housing instability N (%) + Housing instability - Housing instability Total + CRMU 29 (7.1)

75 (18.4)

104 (25.6)

- CRMU 15 (3.7)

288 (70.8)

303 (74.5)

Total 44 (10.8)

363 (89.2)

407 (100.0)

E. Cost-related medication underuse and energy insecurity N (%) + Energy insecurity - Energy insecurity Total + CRMU 33 (8.1)

71 (17.4)

104 (25.6)

- CRMU 39((9.6)

264 (64.9)

303 (74.5)

Total 72 (17.7)

335 (82.3)

407 (100.0)

F. Housing instability and energy insecurity N (%) + Energy insecurity - Energy insecurity Total

+ Housing instability 19 (4.6) 25 (6.1) 44 (10.7)

- Housing instability 53 (12.9) 314 (76.4) 367 (89.3)

Total 72 (17.5) 339 (82.5) 411 (100.0)



eTable 2. Full Models for Material Need Insecurities and Diabetes Mellitus Control Analyses

A. Full model for food insecurity and diabetes control analysisa Variableb ORc 95%CI Food Insecurity 1.97 1.58 - 2.47 Age (y) 0.89 0.79 - 0.99 Age*Age (y) 1.00 1.00 - 1.00 Female 1.13 1.05 - 1.21 Race/ethnicity Asian/Multi-racial/Other 0.79 0.22 - 2.82 Non-Hispanic Black 1.09 0.41 - 2.86 Hispanic 1.61 0.87 - 2.97 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 0.69 0.54 - 0.89 High School Diploma 1.27 0.95 - 1.69 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.60 1.20 - 2.14 Medicare 0.67 0.40 - 1.12 Medicaid 1.22 0.68 - 2.18 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.83 0.62 - 1.12 Charlson Score 0.94 0.86 - 1.02 Low Health Literacy 1.38 1.11 - 1.71 Age at Diabetes Diagnosis 1.04 1.01 - 1.08 Completed survey in English (referent: Spanish) 1.94 1.18 - 3.17 Insulin use 2.16 1.38 - 3.38 Statin use 1.24 0.74 - 2.08 ACEi/ARB used 1.44 0.66 - 3.15 a Composite of HbA1c > 9.0%, LDL cholesterol > 100mg/dL, or blood pressure > 140/90 mm Hg bReferent is ‘secure’ or ‘non-use’ unless otherwise specified cOdds ratio adjusted for all terms in model and clustering due to design effect dAngiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker

B. Full model for cost-related medication underuse and diabetes control analysisa Variableb ORc 95%CI Cost-related Medication Underuse 1.91 1.35 - 2.70 Age (y) 0.89 0.79 - 0.99 Age*Age (y) 1.00 1.00 - 1.00 Female 1.09 0.98 - 1.21 Race/ethnicity Asian/Multi-racial/Other 0.79 0.22 - 2.83 Non-Hispanic Black 1.03 0.35 - 3.02



Hispanic 1.64 0.88 - 3.06 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 0.60 0.47 - 0.76 High School Diploma 1.20 0.97 - 1.47 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.56 1.17 - 2.08 Medicare 0.71 0.42 - 1.18 Medicaid 1.25 0.70 - 2.22 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.83 0.64 - 1.08 Charlson Score 0.94 0.87 - 1.01 Low Health Literacy 1.33 1.10 - 1.62 Age at Diabetes Diagnosis 1.04 1.00 - 1.08 Completed survey in English (referent: Spanish) 1.76 1.11 - 2.78 Insulin use 2.15 1.37 - 3.39 Statin use 1.13 0.73 - 1.75 ACEi/ARB used 1.43 0.74 - 2.74 a Composite of HbA1c > 9.0%, LDL cholesterol > 100mg/dL, or blood pressure > 140/90 mm Hg bReferent is ‘secure’ or ‘non-use’ unless otherwise specified cOdds ratio adjusted for all terms in model and clustering due to design effect dAngiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker

C. Full model for housing instability and diabetes control analysisa Variableb ORc 95%CI Housing Instability 1.10 0.60 - 2.02 Age (y) 0.91 0.80 - 1.02 Age*Age (y) 1.00 1.00 - 1.00 Female 1.12 1.05 - 1.20 Race/ethnicity Asian/Multi-racial/Other 0.73 0.20 - 2.72 Non-Hispanic Black 1.18 0.48 - 2.95 Hispanic 1.56 0.79 - 3.07 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 0.68 0.46 - 1.02 High School Diploma 1.16 0.91 - 1.49 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.59 1.15 - 2.19 Medicare 0.70 0.42 - 1.16 Medicaid 1.28 0.69 - 2.35 Commercial (referent) 1.0 --



Born outside U.S. (referent: born in U.S.) 0.85 0.68 - 1.07 Charlson Score 0.94 0.86 - 1.04 Low Health Literacy 1.40 1.20 - 1.65 Age at Diabetes Diagnosis 1.04 1.00 - 1.08 Completed survey in English (referent: Spanish) 1.89 1.13 - 3.16 Insulin use 2.19 1.41 - 3.42 Statin use 1.12 0.71 - 1.78 ACEi/ARB used 1.35 0.64 - 2.83 aComposite of HbA1c > 9.0%, LDL cholesterol > 100mg/dL, or blood pressure > 140/90 mm Hg bReferent is ‘secure’ or ‘non-use’ unless otherwise specified cOdds ratio adjusted for all terms in model and clustering due to design effect dAngiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker

D. Full model for energy insecurity and diabetes control analysisa Variableb ORc 95%CI Energy Insecurity 1.27 0.88 - 1.69 Age (y) 0.90 0.96 - 1.02 Age*Age (y) 1.00 0.80 - 1.00 Female 1.12 1.00 - 1.20 Race/ethnicity Asian/Multi-racial/Other 0.74 0.21 - 2.58 Non-Hispanic Black 1.16 0.47 - 2.90 Hispanic 1.55 0.81 - 2.96 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 0.68 0.49 - 0.94 High School Diploma 1.16 0.89 - 1.51 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.56 1.13 - 2.16 Medicare 0.70 0.42 - 1.16 Medicaid 1.26 0.69 - 2.31 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.85 0.69 - 1.05 Charlson Score 0.94 0.86 - 1.02 Low Health Literacy 1.41 1.17 - 1.71 Age at Diabetes Diagnosis 1.04 1.00 - 1.08 Completed survey in English (referent: Spanish) 1.84 1.11 - 3.06 Insulin use 2.22 1.40 - 3.53 Statin use 1.12 0.70 - 1.81 ACEi/ARB used 1.38 0.68 - 2.80 aComposite of HbA1c > 9.0%, LDL cholesterol > 100mg/dL, or blood pressure > 140/90 mm Hg bReferent is ‘secure’ or ‘non-use’ unless otherwise specified cOdds ratio adjusted for all terms in model and clustering due to design effect dAngiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker



eTable 3. Full Model for Number of Material Need Insecurities and Diabetes Mellitus Control Analysis Variableb ORc 95%CI Number of Material Needs Insecurities (Referent:0) 1.39 1.18 - 1.63 Age (y) 0.88 0.80 - 0.98 Age*Age (y) 1.00 1.00 - 1.00 Female 1.10 0.99 - 1.22 Race/ethnicity Asian/Multi-racial/Other 0.86 0.23 - 3.26 Non-Hispanic Black 0.96 0.30 - 3.06 Hispanic 1.57 0.80 - 3.09 Non-Hispanic White (referent) 1.00 -- Educational Attainment <High School Diploma 0.65 0.55 - 0.76 High School Diploma 1.24 0.95 - 1.64 Some college or higher (referent) 1.00 -- Health Insurance Self-pay/None/Freecare 1.53 1.21 - 1.95 Medicare 0.69 0.40 - 1.19 Medicaid 1.23 0.73 - 2.07 Commercial (referent) 1.00 -- Born outside U.S. (referent: born in U.S.) 0.81 0.61 - 1.09 Charlson Score 0.93 0.87 - 1.00 Low Health Literacy 1.34 1.08 - 1.65 Age at Diabetes Diagnosis 1.04 1.00 - 1.08 Completed survey in English (referent: Spanish) 1.82 1.09 - 3.02 Insulin use 2.19 1.36 - 3.50 Statin use 1.15 0.70 - 1.90 ACEi/ARB used 1.53 0.74 - 3.14 a Composite of HbA1c > 9.0%, LDL cholesterol > 100mg/dL, or blood pressure > 140/90 mm Hg bReferent is ‘secure’ or ‘non-use’ unless otherwise specified cOdds ratio adjusted for all terms in model and clustering due to design effect dAngiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker



eTable 4. Full Models for Material Need Insecurities and Outpatient Visits Analyses A. Full model for food insecurity and outpatient visit analysis Variablea IRRb 95%CI Food Insecurity 1.19 1.05 - 1.36 Age (y) 1.00 0.99 - 1.00 Female 1.06 1.03 - 1.09 Race/ethnicity Asian/Multi-racial/Other 0.96 0.82 - 1.12 Non-Hispanic Black 0.99 0.93 - 1.06 Hispanic 1.04 0.89 - 1.22 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 1.44 1.24 - 1.67 High School Diploma 1.25 1.12 - 1.39 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.08 0.87 - 1.34 Medicare 0.95 0.82 - 1.10 Medicaid 1.07 0.99 - 1.15 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.98 0.92 - 1.04 Low Health Literacy 1.00 0.95 - 1.05 Age at Diabetes Diagnosis 1.00 1.00 - 1.01 Charlson Score 1.05 1.04 - 1.07 Completed survey in English (referent: Spanish) 0.94 0.83 - 1.05 a Referent is ‘secure’ unless otherwise specified bIncidence rate ratio adjusted for all terms in model and clustering due to design effect

B. Full model for cost-related medication underuse and outpatient visit analysis Variablea IRRb 95%CI Cost-related Medication Underuse 1.07 0.95 - 1.21 Age (y) 0.99 0.99 - 1.00 Female 1.07 1.02 - 1.11 Race/ethnicity Asian/Multi-racial/Other 0.94 0.80 - 1.10 Non-Hispanic Black 1.02 0.95 - 1.10 Hispanic 1.04 0.86 - 1.25 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 1.38 1.19 - 1.60 High School Diploma 1.24 1.11 - 1.39 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.07 0.87 - 1.33



Medicare 0.97 0.86 - 1.10 Medicaid 1.06 0.98 - 1.14 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.99 0.94 - 1.03 Low Health Literacy 1.01 0.96 - 1.05 Age at Diabetes Diagnosis 1.01 1.00 - 1.01 Charlson Score 1.05 1.04 - 1.07 Completed survey in English (referent: Spanish) 0.92 0.80 - 1.07 a Referent is ‘secure’ unless otherwise specified bIncidence rate ratio adjusted for all terms in model and clustering due to design effect

C. Full model for housing instability and outpatient visit analysis Variablea IRRb 95%CI Housing Instability 1.31 1.14 - 1.51 Age (y)

1.00 0.99 - 1.00

Female 1.07 1.03 - 1.10 Race/ethnicity Asian/Multi-racial/Other 0.98 0.85 - 1.13 Non-Hispanic Black 1.00 0.94 - 1.07 Hispanic

1.00 0.83 - 1.20 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 1.42 1.21 - 1.68 High School Diploma 1.24 1.09 - 1.40 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.08 0.85 - 1.37 Medicare 0.94 0.83 - 1.08 Medicaid 1.07 1.00 - 1.16 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.98 0.93 - 1.04 Low Health Literacy 1.00 0.95 - 1.05 Age at Diabetes Diagnosis 1.01 1.00 - 1.01 Charlson Score 1.06 1.05 - 1.06 Completed survey in English (referent: Spanish) 0.95 0.82 - 1.09 a Referent is ‘secure’ unless otherwise specified bIncidence rate ratio adjusted for all terms in model and clustering due to design effect

D. Full model for energy insecurity and outpatient visit analysis Variablea IRRb 95%CI Energy Insecurity 1.12 1.00 - 1.25



Age (y) 0.99 0.99 - 1.00 Female 1.07 1.03 - 1.11 Race/ethnicity Asian/Multi-racial/Other 0.94 0.81 - 1.11 Non-Hispanic Black 1.01 0.95 - 1.07 Hispanic

1.04 0.86 - 1.27 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 1.39 1.19 - 1.61 High School Diploma 1.23 1.12 - 1.36 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.08 0.87 - 1.34 Medicare 0.97 0.85 - 1.10 Medicaid 1.06 0.99 - 1.13 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.98 0.94 - 1.02 Low Health Literacy 1.01 0.97 - 1.06 Age at Diabetes Diagnosis 1.00 1.00 - 1.01 Charlson Score 1.05 1.04 - 1.06 Completed survey in English (referent: Spanish) 0.93 0.80 - 1.07 a Referent is ‘secure’ unless otherwise specified bIncidence rate ratio adjusted for all terms in model and clustering due to design effect



eTable 5. Full Model for Number of Material Need Insecurities and Outpatient Visits AnalysisVariablea IRRb 95%CI Number of Material Needs Insecurities (Referent:0) 1.09 1.03 - 1.15 Age (y) 1.00 0.99 - 1.00 Female 1.06 1.02 - 1.10 Race/ethnicity Asian/Multi-racial/Other 0.97 0.86 - 1.10 Non-Hispanic Black 0.99 0.94 - 1.04 Hispanic 1.02 0.88 - 1.18 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 1.18 1.09 - 1.29 High School Diploma 1.02 0.97 - 1.08 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.06 0.85 - 1.33 Medicare 0.96 0.84 - 1.10 Medicaid 1.07 0.99 - 1.15 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.98 0.92 - 1.03 Low Health Literacy 1.00 0.95 - 1.05 Age at Diabetes Diagnosis 1.00 1.00 - 1.01 Charlson Score 1.05 1.04 - 1.06 Completed survey in English (referent: Spanish) 0.93 0.81 - 1.06 a Referent is ‘secure’ unless otherwise specified bIncidence rate ratio adjusted for all terms in model and clustering due to design effect



eTable 6. Full Models for Material Need Insecurities and Emergency Department/Inpatient Visits Analyses A. Full model for food insecurity and emergency department/inpatient visit analysis Variablea IRRb 95%CI Food Insecurity 1.00 0.51 - 1.97 Age (y) 0.97 0.95 - 0.98 Female 0.97 0.84 - 1.13 Race/ethnicity Asian/Multi-racial/Other 0.68 0.40 - 1.13 Non-Hispanic Black 1.22 0.96 - 1.56 Hispanic 0.96 0.46 - 2.01 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 1.49 1.02 - 2.17 High School Diploma 1.11 0.98 - 1.25 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.01 0.68 - 1.49 Medicare 0.92 0.69 - 1.24 Medicaid 1.41 1.17 - 1.70 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.96 0.76 - 1.19 Low Health Literacy 1.04 0.91 - 1.20 Age at Diabetes Diagnosis 1.02 1.01 - 1.04 Charlson Score 1.26 1.22 - 1.30 Completed survey in English (referent: Spanish) 0.83 0.51 - 1.35 a Referent is ‘secure’ unless otherwise specified bIncidence rate ratio adjusted for all terms in model and clustering due to design effect

B. Full model for cost-related medication underuse and emergency department/inpatient visit analysis Variablea IRRb 95%CI Cost-related Medication Underuse 1.68 1.21 - 2.34 Age (y) 0.97 0.96 - 0.99 Female 1.00 0.87 - 1.15 Race/ethnicity Asian/Multi-racial/Other 0.72 0.52 - 0.99 Non-Hispanic Black 1.14 0.84 - 1.55 Hispanic 0.94 0.49 - 1.81 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 1.44 0.97 - 2.14 High School Diploma 1.11 1.02 - 1.20 Some college or higher (referent) 1.0 --



Health Insurance Self-pay/None/Freecare 0.92 0.65 - 1.30 Medicare 0.91 0.75 - 1.10 Medicaid 1.46 1.19 - 1.80 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.95 0.74 - 1.22 Low Health Literacy 0.99 0.86 - 1.13 Age at Diabetes Diagnosis 1.02 1.01 - 1.03 Charlson Score 1.26 1.24 - 1.28 Completed survey in English (referent: Spanish) 0.79 0.46 - 1.33 a Referent is ‘secure’ unless otherwise specified bIncidence rate ratio adjusted for all terms in model and clustering due to design effect

C. Full model for housing instability and emergency department/inpatient visit analysis Variablea IRRb 95%CI Housing Instability 1.49 0.81 - 2.73 Age (y) 0.97 0.95 - 0.99 Female 0.97 0.84 - 1.12 Race/ethnicity Asian/Multi-racial/Other 0.73 0.47 - 1.13 Non-Hispanic Black 1.20 0.87 - 1.66 Hispanic 0.86 0.41 - 1.81 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 1.55 1.03 - 2.31 High School Diploma 1.08 0.94 - 1.25 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 0.99 0.66 - 1.50 Medicare 0.89 0.73 - 1.10 Medicaid 1.43 1.19 - 1.71 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.96 0.75 - 1.24 Low Health Literacy 1.02 0.86 - 1.22 Age at Diabetes Diagnosis 1.02 1.00 - 1.04 Charlson Score 1.26 1.23 - 1.30 Completed survey in English (referent: Spanish) 0.84 0.54 - 1.28 a Referent is ‘secure’ unless otherwise specified bIncidence rate ratio adjusted for all terms in model and clustering due to design effect



D. Full model for energy insecurity and emergency department/inpatient visit analysis Variablea IRRb 95%CI Energy Insecurity 1.31 0.80 - 2.13 Age (y) 0.97 0.95 - 0.99 Female 0.97 0.85 - 1.10 Race/ethnicity Asian/Multi-racial/Other 0.68 0.43 - 1.06 Non-Hispanic Black 1.18 0.91 - 1.54 Hispanic 0.97 0.45 - 2.08 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 1.53 1.08 - 2.18 High School Diploma 1.12 1.02 - 1.24 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 0.98 0.66 - 1.44 Medicare 0.93 0.71 - 1.21 Medicaid 1.43 1.20 - 1.70 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.94 0.76 - 1.17 Low Health Literacy 1.02 0.88 - 1.19 Age at Diabetes Diagnosis 1.02 1.00 - 1.04 Charlson Score 1.25 1.22 - 1.29 Completed survey in English (referent: Spanish) 0.83 0.50 - 1.37 a Referent is ‘secure’ unless otherwise specified bIncidence rate ratio adjusted for all terms in model and clustering due to design effect



eTable 7. Full Model for Number of Material Need Insecurities and Emergency Department/Inpatient Visits Analysis Variablea IRRb 95%CI Number of Material Needs Insecurities (Referent:0) 1.22 0.99 - 1.51 Age (y) 0.98 0.96 - 0.99 Female 0.98 0.86 - 1.12 Race/ethnicity Asian/Multi-racial/Other 0.73 0.48 - 1.11 Non-Hispanic Black 1.13 0.91 - 1.40 Hispanic 0.92 0.45 - 1.88 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 1.54 1.06 - 2.23 High School Diploma 1.17 1.03 - 1.34 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 0.94 0.64 - 1.39 Medicare 0.90 0.70 - 1.17 Medicaid 1.45 1.19 - 1.76 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.96 0.76 - 1.20 Low Health Literacy 0.99 0.89 - 1.10 Age at Diabetes Diagnosis 1.02 1.00 - 1.03 Charlson Score 1.26 1.23 - 1.29 Completed survey in English (referent: Spanish) 0.81 0.49 - 1.36 a Referent is ‘secure’ unless otherwise specified bIncidence rate ratio adjusted for all terms in model and clustering due to design effect



eTable 8. Full Models for Material Need Insecurities and Hemoglobin A1c Level >9.0% Analyses

A. Full model for food insecurity and hemoglobin A1c > 9.0% analysis Variablea ORb 95%CI Food Insecurity 2.04 1.61 - 2.60 Age (y) 1.14 0.77 - 1.69 Age*Age (y) 1.00 1.00 - 1.00 Female 1.13 0.98 - 1.30 Non-White Race/Ethnicity (referent: Non-Hispanic White) c 0.65 0.47 - 0.92 Educational Attainment <High School Diploma 1.16 0.53 - 2.50 High School Diploma 0.56 0.27 - 1.19 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.52 1.07 - 2.17 Medicare 1.05 0.36 - 3.09 Medicaid 1.21 0.76 - 1.92 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 1.10 0.47 - 2.61 Charlson Score 0.90 0.73 - 1.10 Age at Diabetes Diagnosis 1.00 0.96 - 1.04 Completed survey in English (referent: Spanish) 0.85 0.23 - 3.07 Insulin use 6.12 3.22 - 11.65 a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect cCombined race/ethnicities other than non-Hispanic White due to sample size

B. Full model for cost-related medication underuse and hemoglobin A1c > 9.0% analysisVariablea ORb 95%CI Cost-related Medication Underuse 2.08 1.11 - 3.88 Age (y) 1.14 0.79 - 1.65 Age*Age (y) 1.00 1.00 - 1.00 Female 1.14 1.00 - 1.31 Non-White Race/Ethnicity (referent: Non-Hispanic White) c 0.62 0.46 - 0.83 Educational Attainment <High School Diploma 1.05 0.50 - 2.19 High School Diploma 0.54 0.24 - 1.20 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.38 0.94 - 2.03 Medicare 1.06 0.34 - 3.34 Medicaid 1.34 0.78 - 2.32 Commercial (referent) 1.0 --



Born outside U.S. (referent: born in U.S.) 1.14 0.51 - 2.57 Charlson Score 0.90 0.74 - 1.10 Age at Diabetes Diagnosis 1.00 0.96 - 1.05 Completed survey in English (referent: Spanish) 0.81 0.23 - 2.86 Insulin use 6.23 2.88 - 13.47 a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect cCombined race/ethnicities other than non-Hispanic White due to sample size

C. Full model for housing instability and hemoglobin A1c > 9.0% analysis Variablea ORb 95%CI Housing Instability 1.77 0.64 - 4.88 Age (y) 1.19 0.81 - 1.76 Age*Age (y) 1.00 0.99 - 1.00 Female 1.16 0.99 - 1.35 Non-White Race/Ethnicity (referent: Non-Hispanic White) c 0.62 0.41 - 0.93 Educational Attainment <High School Diploma 1.24 0.64 - 2.40 High School Diploma 0.50 0.23 - 1.12 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.40 0.97 - 2.01 Medicare 1.05 0.39 - 2.82 Medicaid 1.39 0.82 - 2.37 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 1.13 0.48 - 2.70 Charlson Score 0.91 0.76 - 1.09 Age at Diabetes Diagnosis 1.00 0.95 - 1.05 Completed survey in English (referent: Spanish) 0.94 0.29 - 3.10 Insulin use 6.08 2.63 - 14.02 a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect cCombined race/ethnicities other than non-Hispanic White due to sample size



D. Full model for energy insecurity and hemoglobin A1c > 9.0% analysis Variablea ORb 95%CI Energy Insecurity 1.16 0.60 - 2.23 Age (y) 1.18 0.79 - 1.76 Age*Age (y) 1.00 0.99 - 1.00 Female 1.15 1.00 - 1.31 Non-White Race/Ethnicity (referent: Non-Hispanic White) c 0.64 0.45 - 0.92 Educational Attainment <High School Diploma 1.20 0.63 - 2.30 High School Diploma 0.52 0.24 - 1.12 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.39 0.94 - 2.06 Medicare 1.10 0.38 - 3.23 Medicaid 1.37 0.76 - 2.48 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 1.14 0.52 - 2.48 Charlson Score 0.90 0.74 - 1.10 Age at Diabetes Diagnosis 1.00 0.95 - 1.05 Completed survey in English (referent: Spanish) 0.86 0.23 - 3.28 Insulin use 6.49 3.30 - 12.75a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect cCombined race/ethnicities other than non-Hispanic White due to sample size



eTable 9. Full Models for Material Need Insecurities and LDL Cholesterol Level >100 mg/dL Analyses

A. Full model for food insecurity and LDL cholesterol > 100 mg/dL analysis Variablea ORb 95%CI Food Insecurity 1.49 1.13 - 1.98 Age (y) 0.96 0.95 - 0.97 Female 1.26 0.90 - 1.77 Race/ethnicity Asian/Multi-racial/Other 0.78 0.28 - 2.17 Non-Hispanic Black 1.16 0.77 - 1.75 Hispanic 1.47 0.69 - 3.13 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 0.85 0.47 - 1.53 High School Diploma 1.48 1.07 - 2.04 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.17 0.78 - 1.76 Medicare 0.80 0.60 - 1.06 Medicaid 1.28 0.77 - 2.12 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 1.06 0.89 - 1.25 Low Health Literacy 1.20 0.92 - 1.57 Charlson Score 0.93 0.88 - 0.99 Completed survey in English (referent: Spanish) 2.26 1.87 - 2.74 Statin Use 1.05 0.91 - 1.21 a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect



B. Full model for cost-related medication underuse and LDL cholesterol > 100 mg/dL analysisVariablea ORb 95%CI Cost-related Medication Underuse 1.80 1.60 - 2.02 Age (y) 0.97 0.96 - 0.97 Female 1.23 0.84 - 1.81 Race/ethnicity Asian/Multi-racial/Other 0.80 0.29 - 2.27 Non-Hispanic Black 1.08 0.62 - 1.89 Hispanic 1.54 0.67 - 3.52 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 0.68 0.44 - 1.06 High School Diploma 1.50 1.15 - 1.95 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.21 0.84 - 1.74 Medicare 0.82 0.61 - 1.10 Medicaid 1.23 0.76 - 2.01 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 1.07 0.86 - 1.32 Low Health Literacy 1.15 0.87 - 1.53 Charlson Score 0.93 0.89 - 0.98 Completed survey in English (referent: Spanish) 2.11 1.69 - 2.63 Statin Use 0.94 0.80 - 1.10 a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect

C. Full model for housing instability and LDL cholesterol > 100 mg/dL analysis Variablea ORb 95%CI Housing Instability 0.99 0.47 - 2.10 Age (y) 0.96 0.96 - 0.96 Female 1.28 0.91 - 1.82 Race/ethnicity Asian/Multi-racial/Other 0.74 0.24 - 2.25 Non-Hispanic Black 1.26 0.83 - 1.91 Hispanic 1.45 0.61 - 3.43 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 0.76 0.39 - 1.47 High School Diploma 1.42 1.08 - 1.88 Some college or higher (referent) 1.0 -- Health Insurance



Self-pay/None/Freecare 1.20 0.82 - 1.75 Medicare 0.81 0.61 - 1.07 Medicaid 1.28 0.79 - 2.06 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 1.09 0.94 - 1.26 Low Health Literacy 1.22 0.89 - 1.67 Charlson Score 0.94 0.88 - 1.01 Completed survey in English (referent: Spanish) 2.17 1.81 - 2.60 Statin Use 0.97 0.81 - 1.17 a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect

D. Full model for energy insecurity and LDL cholesterol > 100 mg/dL analysis Variablea ORb 95%CI Energy Insecurity 1.11 0.75 - 1.64 Age (y) 0.96 0.95 - 0.97 Female 1.28 0.91 - 1.80 Race/ethnicity Asian/Multi-racial/Other 0.75 0.27 - 2.04 Non-Hispanic Black 1.24 0.87 - 1.76 Hispanic 1.44 0.64 - 3.27 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 0.76 0.43 - 1.35 High School Diploma 1.42 1.07 - 1.87 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.19 0.82 - 1.74 Medicare 0.80 0.62 - 1.05 Medicaid 1.27 0.78 - 2.08 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 1.09 0.95 - 1.25 Low Health Literacy 1.22 0.91 - 1.64 Charlson Score 0.94 0.88 - 1.01 Completed survey in English (referent: Spanish) 2.17 1.80 - 2.61 Statin Use 0.97 0.81 - 1.15 a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect



eTable 10. Full Models for Material Need Insecurities and Blood Pressure >140/90 mm Hg Analyses A. Full model for food insecurity and blood pressure > 140/90 mm Hg analysis Variablea ORb 95%CI Food Insecurity 1.58 0.66 - 3.76 Age (y) 0.99 0.98 - 1.00 Female 0.93 0.73 - 1.18 Non-White Race/Ethnicity (referent: Non-Hispanic White)c 1.10 0.53 - 2.31 Educational Attainment <High School Diploma 0.92 0.56 - 1.53 High School Diploma 1.31 0.84 - 2.05 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 0.79 0.32 - 1.94 Medicare 0.91 0.63 - 1.30 Medicaid 1.20 0.67 - 2.12 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.55 0.38 - 0.81 Low Health Literacy 1.11 0.98 - 1.26 Age at Diabetes Diagnosis 1.02 1.00 - 1.04 Completed survey in English (referent: Spanish) 0.91 0.44 - 1.86 ACEi/ARB used 1.50 0.48 - 4.73 Beta-blocker use 1.48 0.94 - 2.32 Calcium Channel Blocker use 2.06 1.48 - 2.87 ‘Thiazide’ use 0.93 0.42 - 2.06 TZDe use 1.05 0.36 - 3.00 Statin use 1.36 0.57 - 3.21 Insulin use 0.89 0.54 - 1.46 Sulfonylurea use 1.64 0.87 - 3.10 Combination anti-hypertensive use 1.76 0.67 - 4.61 a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect cCombined race/ethnicities other than non-Hispanic White due to sample size dAngiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker eThiazolidinediones

B. Full model for cost-related medication underuse and blood pressure > 140/90 mm Hg analysisVariablea ORb 95%CI Cost-related Medication Underuse 1.82 1.03 - 3.22 Age (y) 0.99 0.97 - 1.00 Female 0.93 0.75 - 1.17 Non-White Race/Ethnicity (referent: Non-Hispanic White)c 1.09 0.50 - 2.37 Educational Attainment <High School Diploma 0.82 0.41 - 1.64



High School Diploma 1.26 0.75 - 2.12 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 0.75 0.31 - 1.79 Medicare 0.95 0.65 - 1.40 Medicaid 1.19 0.67 - 2.14 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.55 0.38 - 0.80 Low Health Literacy 1.10 0.95 - 1.26 Age at Diabetes Diagnosis 1.02 1.00 - 1.04 Completed survey in English (referent: Spanish) 0.81 0.40 - 1.64 ACEi/ARB used 1.63 0.62 - 4.26 Beta-blocker use 1.51 1.01 - 2.24 Calcium Channel Blocker use 2.09 1.49 - 2.93 ‘Thiazide’ use 0.89 0.39 - 2.04 TZDe use 1.06 0.38 - 2.97 Statin use 1.35 0.58 - 3.13 Insulin use 0.89 0.57 - 1.38 Sulfonylurea use 1.53 0.91 - 2.58 Combination anti-hypertensive use 1.78 0.69 - 4.62 a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect cCombined race/ethnicities other than non-Hispanic White due to sample size dAngiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker eThiazolidinediones

C. Full model for housing instability and blood pressure > 140/90 mm Hg analysis Variablea ORb 95%CI Housing Instability 0.93 0.63 - 1.37 Age (y) 0.98 0.97 - 0.99 Female 0.92 0.75 - 1.14 Non-White Race/Ethnicity (referent: Non-Hispanic White)c 1.13 0.51 - 2.52 Educational Attainment <High School Diploma 0.88 0.54 - 1.45 High School Diploma 1.23 0.77 - 1.98 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 0.80 0.34 - 1.88 Medicare 0.93 0.64 - 1.35 Medicaid 1.21 0.71 - 2.06 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.56 0.37 - 0.84 Low Health Literacy 1.13 1.00 - 1.28 Age at Diabetes Diagnosis 1.01 0.99 - 1.04



Completed survey in English (referent: Spanish) 0.88 0.44 - 1.77 ACEi/ARB used 1.52 0.48 - 4.85 Beta-blocker use 1.46 0.94 - 2.28 Calcium Channel Blocker use 2.03 1.44 - 2.87 ‘Thiazide’ use 0.95 0.42 - 2.16 TZDe use 1.07 0.36 - 3.17 Statin use 1.26 0.52 - 3.04 Insulin use 0.89 0.56 - 1.43 Sulfonylurea use 1.64 0.85 - 3.13 Combination anti-hypertensive use 1.70 0.64 - 4.53 a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect cCombined race/ethnicities other than non-Hispanic White due to sample size dAngiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker eThiazolidinediones

D. Full model for energy insecurity and blood pressure > 140/90 mm Hg analysis Variablea ORb 95%CI Energy Insecurity 1.29 0.76 - 2.21 Age (y) 0.99 0.98 - 0.99 Female 0.92 0.75 - 1.15 Non-White Race/Ethnicity (referent: Non-Hispanic White)c 1.10 0.50 - 2.41 Educational Attainment <High School Diploma 0.89 0.57 - 1.39 High School Diploma 1.24 0.77 - 1.98 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 0.80 0.34 - 1.89 Medicare 0.91 0.61 - 1.36 Medicaid 1.21 0.72 - 2.03 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.56 0.37 - 0.84 Low Health Literacy 1.12 0.99 - 1.27 Age at Diabetes Diagnosis 1.02 0.99 - 1.04 Completed survey in English (referent: Spanish) 0.89 0.43 - 1.86 ACEi/ARB used 1.55 0.49 - 4.90 Beta-blocker use 1.47 0.92 - 2.35 Calcium Channel Blocker use 2.01 1.42 - 2.86 ‘Thiazide’ use 0.95 0.41 - 2.17 TZDe use 1.07 0.37 - 3.15 Statin use 1.25 0.50 - 3.10 Insulin use 0.89 0.55 - 1.45 Sulfonylurea use 1.62 0.83 - 3.16 Combination anti-hypertensive use 1.73 0.65 - 4.65



a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect cCombined race/ethnicities other than non-Hispanic White due to sample size dAngiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker eThiazolidinediones



eTable 11. Full Model for All 4 Material Need Insecurities and Diabetes Mellitus Control Analysis a Variableb ORc 95%CI Food Insecurity 1.70 1.01 - 2.86 Cost-related Medication Underuse 1.72 1.10 - 2.68 Housing Instability 0.80 0.34 - 1.87 Energy Insecurity 1.12 0.75 - 1.67 Age (y) 0.87 0.77 - 0.98 Age*Age (y) 1.00 1.00 - 1.00 Female 1.10 0.99 - 1.23 Race/ethnicity Asian/Multi-racial/Other 0.81 0.20 - 3.24 Non-Hispanic Black 0.97 0.29 - 3.21 Hispanic 1.71 0.86 - 3.42 Non-Hispanic White (referent) 1.00 -- Educational Attainment <High School Diploma 0.59 0.47 - 0.75 High School Diploma 1.28 0.99 - 1.66 Some college or higher (referent) 1.00 -- Health Insurance Self-pay/None/Freecare 1.55 1.15 - 2.10 Medicare 0.70 0.41 - 1.18 Medicaid 1.20 0.69 - 2.09 Commercial (referent) 1.00 -- Born outside U.S. (referent: born in U.S.) 0.81 0.60 - 1.10 Charlson Score 0.93 0.86 - 1.00 Low Health Literacy 1.34 1.09 - 1.64 Age at Diabetes Diagnosis 1.04 1.00 - 1.08 Completed survey in English (referent: Spanish) 1.78 1.20 - 2.62 Insulin use 2.20 1.39 - 3.47 Statin use 1.21 0.82 - 1.81 ACEi/ARB used 1.51 0.76 - 2.99 a Composite of HbA1c > 9.0%, LDL cholesterol > 100mg/dL, or blood pressure > 140/90 mm Hg bReferent is ‘secure’ or ‘non-use’ unless otherwise specified cOdds ratio adjusted for all terms in model and clustering due to design effect dAngiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker



eTable 12. Full Model for All 4 Material Need Insecurities and Outpatient Visits AnalysisVariablea IRRb 95%CI Food Insecurity 1.13 1.01 - 1.28 Cost-related Medication Underuse 0.97 0.86 - 1.10 Housing Instability 1.23 1.12 - 1.35 Energy Insecurity 1.05 0.97 - 1.15 Age (y) 1.00 0.99 - 1.00 Female 1.06 1.02 - 1.10 Race/ethnicity Asian/Multi-racial/Other 0.98 0.86 - 1.13 Non-Hispanic Black 1.00 0.95 - 1.05 Hispanic 1.00 0.84 - 1.18 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 1.47 1.26 - 1.73 High School Diploma 1.24 1.11 - 1.39 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.08 0.86 - 1.35 Medicare 0.94 0.82 - 1.08 Medicaid 1.07 1.00 - 1.16 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.98 0.92 - 1.05 Low Health Literacy 0.99 0.94 - 1.05 Age at Diabetes Diagnosis 1.00 1.00 - 1.01 Charlson Score 1.05 1.04 - 1.06 Completed survey in English (referent: Spanish) 0.95 0.83 - 1.08 a Referent is ‘secure’ unless otherwise specified

bIncidence rate ratio adjusted for all terms in model and clustering due to design effect



eTable 13. Full Model for All 4 Material Need Insecurities and Emergency Department/Inpatient Visits Analysis Variablea IRRb 95%CI Food Insecurity 0.71 0.41 - 1.23 Cost-related Medication Underuse 1.77 1.38 - 2.26 Housing Instability 1.32 0.63 - 2.78 Energy Insecurity 1.24 0.85 - 1.81 Age (y) 0.97 0.96 - 0.99 Female 1.00 0.86 - 1.17 Race/ethnicity Asian/Multi-racial/Other 0.73 0.53 - 1.00 Non-Hispanic Black 1.14 0.83 - 1.57 Hispanic 0.87 0.47 - 1.60 Non-Hispanic White (referent) 1.0 -- Educational Attainment <High School Diploma 1.49 0.98 - 2.28 High School Diploma 1.09 0.95 - 1.27 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 0.87 0.61 - 1.23 Medicare 0.91 0.76 - 1.10 Medicaid 1.51 1.26 - 1.80 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.95 0.72 - 1.24 Low Health Literacy 1.00 0.87 - 1.16 Age at Diabetes Diagnosis 1.02 1.01 - 1.03 Charlson Score 1.27 1.23 - 1.31 Completed survey in English (referent: Spanish) 0.78 0.48 - 1.28 a Referent is ‘secure’ unless otherwise specified bIncidence rate ratio adjusted for all terms in model and clustering due to design effect



eTable 14. Full Model for All 4 Material Need Insecurities and Hemoglobin A1c Level >9.0% Analysis Variablea ORb 95%CI Food Insecurity 1.59 1.11 - 2.26 Cost-related Medication Underuse 1.66 0.67 - 4.10 Housing Instability 1.29 0.38 - 4.41 Energy Insecurity 0.96 0.44 - 2.10 Age (y) 1.13 0.78 - 1.64 Age*Age (y) 1.00 1.00 - 1.00 Female 1.15 0.99 - 1.33 Non-White Race/Ethnicity (referent: Non-Hispanic White) c 0.63 0.45 - 0.88 Educational Attainment <High School Diploma 1.05 0.44 - 2.49 High School Diploma 0.55 0.23 - 1.29 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 1.46 1.05 - 2.05 Medicare 1.02 0.37 - 2.83 Medicaid 1.23 0.79 - 1.92 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 1.12 0.45 - 2.76 Charlson Score 0.91 0.76 - 1.08 Age at Diabetes Diagnosis 1.00 0.96 - 1.05 Completed survey in English (referent: Spanish) 0.84 0.29 - 2.46 Insulin use 5.78 2.46 - 13.59 a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect cCombined race/ethnicities other than non-Hispanic White due to sample size



eTable 15. Full Model for All 4 Material Need Insecurities and LDL Cholesterol Level >100 mg/dL Analysis Variablea ORb 95%CI Food Insecurity 1.31 0.98 - 1.75Cost-related Medication Underuse 1.76 1.33 - 2.32Housing Instability 0.75 0.31 - 1.80Energy Insecurity 1.02 0.72 - 1.45Age (y) 0.97 0.96 - 0.97Female 1.23 0.84 - 1.80Race/ethnicity Asian/Multi-racial/Other 0.80 0.25 - 2.59 Non-Hispanic Black 1.04 0.56 - 1.94 Hispanic 1.61 0.71 - 3.65 Non-Hispanic White (referent) 1.0 --Educational Attainment <High School Diploma 0.72 0.42 - 1.23 High School Diploma 1.54 1.17 - 2.02 Some college or higher (referent) 1.0 --Health Insurance Self-pay/None/Freecare 1.17 0.80 - 1.72 Medicare 0.84 0.63 - 1.12 Medicaid 1.23 0.71 - 2.14 Commercial (referent) 1.0 --Born outside U.S. (referent: born in U.S.) 1.04 0.84 - 1.28Low Health Literacy 1.17 0.87 - 1.58Charlson Score 0.93 0.88 - 0.97Completed survey in English (referent: Spanish) 2.13 1.65 - 2.75Statin Use 1.01 0.85 - 1.20a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect



eTable 16. Full Model for All 4 Material Need Insecurities and Blood Pressure >140/90 mm Hg Analysis Variablea ORb 95%CI Food Insecurity 1.36 0.44 - 4.22 Cost-related Medication Underuse 1.67 1.01 - 2.77 Housing Instability 0.71 0.32 - 1.58 Energy Insecurity 1.13 0.50 - 2.54 Age (y) 0.99 0.98 - 1.00 Female 0.93 0.73 - 1.19 Non-White Race/Ethnicity (referent: Non-Hispanic White)c 1.08 0.49 - 2.39 Educational Attainment <High School Diploma 0.83 0.42 - 1.61 High School Diploma 1.30 0.83 - 2.02 Some college or higher (referent) 1.0 -- Health Insurance Self-pay/None/Freecare 0.76 0.31 - 1.82 Medicare 0.93 0.63 - 1.37 Medicaid 1.17 0.64 - 2.14 Commercial (referent) 1.0 -- Born outside U.S. (referent: born in U.S.) 0.55 0.37 - 0.82 Low Health Literacy 1.09 0.94 - 1.27 Age at Diabetes Diagnosis 1.02 0.99 - 1.04 Completed survey in English (referent: Spanish) 0.82 0.40 - 1.69 ACEi/ARB used 1.62 0.62 - 4.21 Beta-blocker use 1.51 0.99 - 2.33 Calcium Channel Blocker use 2.09 1.52 - 2.88 ‘Thiazide’ use 0.89 0.38 - 2.10 TZDe use 1.05 0.38 - 2.91 Statin use 1.41 0.68 - 2.93 Insulin use 0.88 0.54 - 1.43 Sulfonylurea use 1.53 0.89 - 2.62 Combination anti-hypertensive use 1.84 0.69 - 4.95 a Referent is ‘secure’ or ‘non-use’ unless otherwise specified bOdds ratio adjusted for all terms in model and clustering due to design effect cCombined race/ethnicities other than non-Hispanic White due to sample size dAngiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker eThiazolidinediones


supplementary material · full models for material need insecurities and diabetes mellitus control...

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