J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 14, Number 10, October 2022, pages 400-408

Patient Portal Use Among Diabetic Patients With Different Races and Ethnicities

**Table 1.** Description of the Study Population (N = 77,977)
	NHW	NHB	Hispanic/Latino	P value
*P < 0.0001 (group 1 vs. group 2, group 1 vs. group 3, and group 2 vs. group 3). SD: standard deviation; IQR: interquartile range; NHB: non-Hispanic black; NHW: non-Hispanic white; COPD: chronic obstructive pulmonary disease; CAD: coronary artery disease; CHF: congestive heart failure.
Number of patients (n)	26,463	25,939	25,575
Patient portal use (n, %)				< 0.0001
No	20,043 (76)	21,008 (81)	21,026 (82)
Yes	6,420 (24)	4,931 (19)	4,549 (18)
Age (years)
Mean (SD)	46 (16)	44 (16)	43 (17)	< 0.0001
Median (IQR)	47 (33 - 58)	43 (30 - 57)	41 (29 - 55)	< 0.0001*
Sex (n, %)				< 0.0001
Male	13,995 (53)	12,692 (49)	11,820 (46)
Female	12,467 (47)	13,247 (51)	13,754 (54)
Language spoken (n, %)				< 0.0001
English	26,198 (99)	24,969 (96)	14,988 (59)
Spanish	62 (0.2)	8 (0.03)	10,505 (41)
Others	203 (0.8)	962 (3.7)	82 (0.3)
Insurance coverage (n, %)				< 0.0001
Yes	17,841 (67)	17,800 (69)	14,304 (56)
No	8,594 (33)	8,116 (31)	11,247 (44)
Has primary care physician (n, %)				<0.0001
Yes	13,733 (52)	15,231 (59)	12,885 (50)
No	12,730 (48)	10,708 (41)	12,690 (50)
History of diabetes (yes) n, %	5,221 (20)	5,974 (23)	7,028 (27)	< 0.0001
History of hypertension (yes) n, %	11,589 (44)	13,239 (51)	9,671 (38)	< 0.0001
History of back pain (yes) n, %	5,419 (20)	6,029 (23)	4,300 (17)	< 0.0001
History of headache (yes) n, %	4,027 (15)	4,594 (18)	4,125 (16)	< 0.0001
History of asthma/COPD (yes) n, %	6,124 (23)	5,383 (21)	2,561 (10)	< 0.0001
History of hyperlipidemia (yes) n, %	5,735 (22)	5,383 (21)	5,306 (21)	0.011
History of obesity (yes) n, %	5,086 (19)	4,946 (19)	5,131 (20)	0.009
History of depression (yes) n, %	10,963 (41)	7,370 (28)	5,708 (22)	< 0.0001
History of CAD/CHF (yes) n, %	4,368 (17)	3,966 (15)	2,596 (10)	< 0.0001

Table 1. Description of the Study Population (N = 77,977)

NHW

NHB

Hispanic/Latino

P value

*P < 0.0001 (group 1 vs. group 2, group 1 vs. group 3, and group 2 vs. group 3). SD: standard deviation; IQR: interquartile range; NHB: non-Hispanic black; NHW: non-Hispanic white; COPD: chronic obstructive pulmonary disease; CAD: coronary artery disease; CHF: congestive heart failure.

Number of patients (n)

26,463

25,939

25,575

Patient portal use (n, %)

< 0.0001

20,043 (76)

21,008 (81)

21,026 (82)

Yes

6,420 (24)

4,931 (19)

4,549 (18)

Age (years)

Mean (SD)

46 (16)

44 (16)

43 (17)

< 0.0001

Median (IQR)

47 (33 - 58)

43 (30 - 57)

41 (29 - 55)

< 0.0001*

Sex (n, %)

< 0.0001

Male

13,995 (53)

12,692 (49)

11,820 (46)

Female

12,467 (47)

13,247 (51)

13,754 (54)

Language spoken (n, %)

< 0.0001

English

26,198 (99)

24,969 (96)

14,988 (59)

Spanish

62 (0.2)

8 (0.03)

10,505 (41)

Others

203 (0.8)

962 (3.7)

82 (0.3)

Insurance coverage (n, %)

< 0.0001

Yes

17,841 (67)

17,800 (69)

14,304 (56)

8,594 (33)

8,116 (31)

11,247 (44)

Has primary care physician (n, %)

<0.0001

Yes

13,733 (52)

15,231 (59)

12,885 (50)

12,730 (48)

10,708 (41)

12,690 (50)

History of diabetes (yes) n, %

5,221 (20)

5,974 (23)

7,028 (27)

< 0.0001

History of hypertension (yes) n, %

11,589 (44)

13,239 (51)

9,671 (38)

< 0.0001

History of back pain (yes) n, %

5,419 (20)

6,029 (23)

4,300 (17)

< 0.0001

History of headache (yes) n, %

4,027 (15)

4,594 (18)

4,125 (16)

< 0.0001

History of asthma/COPD (yes) n, %

6,124 (23)

5,383 (21)

2,561 (10)

< 0.0001

History of hyperlipidemia (yes) n, %

5,735 (22)

5,383 (21)

5,306 (21)

0.011

History of obesity (yes) n, %

5,086 (19)

4,946 (19)

5,131 (20)

0.009

History of depression (yes) n, %

10,963 (41)

7,370 (28)

5,708 (22)

< 0.0001

History of CAD/CHF (yes) n, %

4,368 (17)

3,966 (15)

2,596 (10)

< 0.0001

**Table 2.** Patient PP Use Among ED Patients With Different Races/Ethnicities
	NHW	NHB	Hispanic/Latino	P value
ED: emergency department; PP: patient portal; DM: diabetes mellitus.
Group 1: patients with no chronic disease (n = 16,177)
Number of patients, n	4,549	4,868	6,760
PP use (n, %)				0.001
Yes	455 (10)	516 (11)	581 (9)
No	4,094 (90)	4,352 (89)	6,179 (91)
Group 2: patients with only a history of DM (n = 1,041)
Number of patients, n	189	209	643
PP use (n, %)				0.004
Yes	29 (15)	41 (20)	70 (11)
No	160 (85)	168 (80)	573 (89)
Group 3: patients with one chronic disease but not DM (n = 14,988)
Number of patients (n)	4,877	4,905	5,206
PP use (n, %)				0.001
Yes	851 (17)	762 (16)	767 (15)
No	4,026 (83)	4,143 (84)	4,439 (85)
Group 4: patients with multimorbidity including a history of DM (n = 17,182)
Number of patients (n)	5,032	5,765	6,385
PP use (n, %)				< 0.0001
Yes	1,784 (35)	1,432 (25)	1,544 (24)
No	3,248 (65)	4,333 (75)	4,841 (76)
Group 5: patients with multimorbidity without a history of DM (n = 28,589)
Number of patients (n)	11,816	10,192	6,581
PP use (n, %)				< 0.0001
Yes	3,301 (28)	2,180 (21)	1,587 (24)
No	8,515 (72)	8,012 (79)	4,994 (76)

Table 2. Patient PP Use Among ED Patients With Different Races/Ethnicities

NHW

NHB

Hispanic/Latino

P value

ED: emergency department; PP: patient portal; DM: diabetes mellitus.

Group 1: patients with no chronic disease (n = 16,177)

Number of patients, n

4,549

4,868

6,760

PP use (n, %)

0.001

Yes

455 (10)

516 (11)

581 (9)

4,094 (90)

4,352 (89)

6,179 (91)

Group 2: patients with only a history of DM (n = 1,041)

Number of patients, n

189

209

643

PP use (n, %)

0.004

Yes

29 (15)

41 (20)

70 (11)

160 (85)

168 (80)

573 (89)

Group 3: patients with one chronic disease but not DM (n = 14,988)

Number of patients (n)

4,877

4,905

5,206

PP use (n, %)

0.001

Yes

851 (17)

762 (16)

767 (15)

4,026 (83)

4,143 (84)

4,439 (85)

Group 4: patients with multimorbidity including a history of DM (n = 17,182)

Number of patients (n)

5,032

5,765

6,385

PP use (n, %)

< 0.0001

Yes

1,784 (35)

1,432 (25)

1,544 (24)

3,248 (65)

4,333 (75)

4,841 (76)

Group 5: patients with multimorbidity without a history of DM (n = 28,589)

Number of patients (n)

11,816

10,192

6,581

PP use (n, %)

< 0.0001

Yes

3,301 (28)

2,180 (21)

1,587 (24)

8,515 (72)

8,012 (79)

4,994 (76)

**Table 3.** Factors Associated With PP Use Among ED Patients
	AOR	95% CI	P value
AOR: adjusted odds ratio; CI: confidence interval; ED: emergency department; PP: patient portal; DM: diabetes mellitus; NHB: non-Hispanic black; NHW: non-Hispanic white.
Age	0.99	0.98 - 0.99	< 0.0001
Sex
Male	Reference	Reference
Female	2.09	2.01 - 2.17	< 0.0001
Race/ethnicity
NHW	Reference	Reference
NHB	0.61	0.58 - 0.64	< 0.0001
Hispanic/Latino	0.91	0.86 - 0.96	< 0.0001
Language speaking
English	Reference	Reference
Spanish	0.40	0.37 - 0.43	< 0.0001
Other languages	0.64	0.55 - 0.76	< 0.0001
Primary care physicians
No	Reference	Reference
Yes	3.89	3.71 - 4.07	< 0.0001
Insurance coverage
No	Reference	Reference
Yes	2.12	2.02 - 2.23	< 0.0001
Chronic disease condition
No chronic disease	Reference	Reference
Only history of DM	1.34	1.10 - 1.64	0.004
One chronic disease without DM	1.45	1.35 - 1.56	< 0.0001
Multimorbidity with DM	2.43	2.26 - 2.61	< 0.0001
Multimorbidity without DM	2.06	1.93 - 2.20	< 0.0001

Table 3. Factors Associated With PP Use Among ED Patients

AOR

95% CI

P value

AOR: adjusted odds ratio; CI: confidence interval; ED: emergency department; PP: patient portal; DM: diabetes mellitus; NHB: non-Hispanic black; NHW: non-Hispanic white.

Age

0.99

0.98 - 0.99

< 0.0001

Sex

Male

Reference

Female

2.09

2.01 - 2.17

< 0.0001

Race/ethnicity

NHW

Reference

NHB

0.61

0.58 - 0.64

< 0.0001

Hispanic/Latino

0.91

0.86 - 0.96

< 0.0001

Language speaking

English

Reference

Spanish

0.40

0.37 - 0.43

< 0.0001

Other languages

0.64

0.55 - 0.76

< 0.0001

Primary care physicians

Reference

Yes

3.89

3.71 - 4.07

< 0.0001

Insurance coverage

Reference

Yes

2.12

2.02 - 2.23

< 0.0001

Chronic disease condition

No chronic disease

Reference

Only history of DM

1.34

1.10 - 1.64

0.004

One chronic disease without DM

1.45

1.35 - 1.56

< 0.0001

Multimorbidity with DM

2.43

2.26 - 2.61

< 0.0001

Multimorbidity without DM

2.06

1.93 - 2.20

< 0.0001

**Table 4.** Factors Associated With Serum Glycemic Control and ED Disposition Among Diabetic Patients
	Serum glycemic control (normal vs. abnormal serum glucose)	ED disposition (no hospitalization vs. hospitalization)
AOR: adjusted odds ratio; CI: confidence interval; ED: emergency department; PP: patient portal; DM: diabetes mellitus; NHB: non-Hispanic black; NHW: non-Hispanic white.

Serum glucose upon ED arrival
Normal		Reference
Abnormal		1.17 (1.09 - 1.25), P < 0.0001
PP use
No PP use	Reference	Reference
PP use	0.98 (0.90 - 1.05), P = 0.547	0.79 (0.73 - 0.86), P < 0.0001
Age	0.99 (0.98 - 0.99), P < 0.0001	1.03 (1.02 - 1.03), P < 0.0001
Sex
Male	Reference	Reference
Female	0.86 (0.81 - 0.92), P < 0.0001	0.65 (0.61 - 0.70), P < 0.0001
Race/ethnicity
NHW	Reference	Reference
NHB	0.85 (0.78 - 0.93), P < 0.0001	0.80 (0.74 - 0.87), P < 0.0001
Hispanic/Latino	1.12 (1.02 - 1.23), P = 0.016	0.82 (0.74 - 0.90), P < 0.0001
Language speaking
English	Reference	Reference
Spanish	1.02 (0.92 - 1.13), P = 0.692	1.08 (0.97 - 1.20), P = 0.177
Other languages	1.09 (0.83 - 1.43), P = 0.521	0.66 (0.49 - 0.88), P = 0.005
Primary care physicians
No	Reference	Reference
Yes	1.03 (0.95 - 1.11), P = 0.504	0.58 (0.53 - 0.63), P < 0.0001
Insurance coverage
No	Reference	Reference
Yes	0.82 (0.75 - 0.89), P < 0.0001	1.65 (1.51 - 1.81), P < 0.0001
Chronic disease condition
Only history of DM	Reference	Reference
Multimorbidity with DM	0.67(0.58 - 0.78), P < 0.0001	2.16 (1.82 - 2.58), P < 0.0001

Table 4. Factors Associated With Serum Glycemic Control and ED Disposition Among Diabetic Patients

Serum glycemic control (normal vs. abnormal serum glucose)

ED disposition (no hospitalization vs. hospitalization)

AOR with 95% CI, P value

AOR: adjusted odds ratio; CI: confidence interval; ED: emergency department; PP: patient portal; DM: diabetes mellitus; NHB: non-Hispanic black; NHW: non-Hispanic white.

Serum glucose upon ED arrival

Normal

Reference

Abnormal

1.17 (1.09 - 1.25), P < 0.0001

PP use

No PP use

Reference

PP use

0.98 (0.90 - 1.05), P = 0.547

0.79 (0.73 - 0.86), P < 0.0001

Age

0.99 (0.98 - 0.99), P < 0.0001

1.03 (1.02 - 1.03), P < 0.0001

Sex

Male

Reference

Female

0.86 (0.81 - 0.92), P < 0.0001

0.65 (0.61 - 0.70), P < 0.0001

Race/ethnicity

NHW

Reference

NHB

0.85 (0.78 - 0.93), P < 0.0001

0.80 (0.74 - 0.87), P < 0.0001

Hispanic/Latino

1.12 (1.02 - 1.23), P = 0.016

0.82 (0.74 - 0.90), P < 0.0001

Language speaking

English

Reference

Spanish

1.02 (0.92 - 1.13), P = 0.692

1.08 (0.97 - 1.20), P = 0.177

Other languages

1.09 (0.83 - 1.43), P = 0.521

0.66 (0.49 - 0.88), P = 0.005

Primary care physicians

Reference

Yes

1.03 (0.95 - 1.11), P = 0.504

0.58 (0.53 - 0.63), P < 0.0001

Insurance coverage

Reference

Yes

0.82 (0.75 - 0.89), P < 0.0001

1.65 (1.51 - 1.81), P < 0.0001

Chronic disease condition

Only history of DM

Reference

Multimorbidity with DM

0.67(0.58 - 0.78), P < 0.0001

2.16 (1.82 - 2.58), P < 0.0001