Association between utilization of community- based chronic disease examination services and disease control outcomes among patients with hypertension and diabetes

Community-based chronic disease examination services (CCDES) constitute a critical component of chronic disease management. The utilization of these services may be associated with patients’ disease control outcomes. Nevertheless, empirical evidence in this domain remains limited. This study aims to investigate the relationship between these two factors and elucidate the potential underlying mechanisms. Data for this study were derived from the 2018 China Health and Retirement Longitudinal Study (CHARLS). A total of 6576 middle-aged and older adults diagnosed with hypertension and diabetes were included. CCDES utilization was assessed using participants’ self-reported service use and frequency, recorded as CCDES_Use and CCDES_Usage_Frequency, respectively. Disease control outcomes were evaluated based on the hypertension and diabetes control status of the participants. Chi-square tests were performed to compare differences across groups. Logistic regression models were utilized to explore the associations between CCDES utilization and disease control outcomes. Subgroup analyses were performed to investigate potential heterogeneity stratified by the number of chronic diseases and residence. Additionally, mediation analyses were performed to examine the mediating role of medical treatment and physical activity in the aforementioned associations. Compared with non‑users and infrequent users of CCDES, users and frequent users were more likely to achieve disease control(p < 0.05). After adjusting for confounders, individuals using CCDES had 34.6% higher odds of achieving disease control than non‑users (aOR = 1.346, 95% CI: 1.151–1.574). Moreover, each one‑unit increase in CCDES utilization was associated with a 6.5% higher odds of disease control (aOR = 1.065, 95% CI: 1.028–1.104). These associations were also observed in both hypertension (CCDES_Use: aOR = 1.361, 95% CI: 1.152–1.609; CCDES_Usage_Frequency: aOR = 1.061, 95% CI: 1.022–1.101) and diabetes (CCDES_Use: aOR = 1.473, 95% CI: 1.098–1.976; CCDES_Usage_Frequency: aOR = 1.087, 95% CI: 1.015–1.164) subgroups. Heterogeneity analyses revealed that CCDES utilization was more strongly associated with disease control outcomes among participants with a single chronic disease and among rural residents, whereas no significant association was observed among those with multimorbidity or urban residents. Mediation analyses indicated that medical treatment acted as a mediator in this association, while physical activity showed no mediating effect. This study provides evidence for an association between CCDES utilization and disease control outcomes. The findings underscore the importance of proactive chronic disease management, especially the utilization of examination services provided by primary healthcare facilities, as such strategies may help reduce adverse chronic disease–related health outcomes.