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01-11-2017 | Healthcare systems | Article

Racial/Ethnic Disparities in Diabetes Quality of Care: the Role of Healthcare Access and Socioeconomic Status

Journal: Journal of Racial and Ethnic Health Disparities

Authors: Juan R. Canedo, Stephania T. Miller, David Schlundt, Mary K. Fadden, Maureen Sanderson

Publisher: Springer International Publishing

Abstract

Introduction

Blacks, Hispanics, and Asians are disproportionately affected by diabetes. We assessed the state of racial/ethnic disparities in diabetes quality of care in the USA.

Methods

We analyzed cross-sectional data of adults diagnosed with Type 2 diabetes in the nationally representative 2013 Medical Expenditure Panel Survey. Differences in adherence to five diabetes quality of care recommendations (HbA1c twice yearly, yearly foot exam, dilated eye exam, blood cholesterol test, and flu vaccination) were examined by race/ethnicity while controlling for three social determinants of health (health insurance status, poverty, and education) and other demographic variables.

Results

Among adults with diabetes in the USA, 74.9% received two or more HbA1c tests, 69.0% had a foot exam, 64.9% had an eye exam, 85.4% had a cholesterol test, and 65.1% received flu vaccination in 2013. Compared to Whites, all were lower for Hispanics; HbA1c tests, eye exam, and flu vaccination were lower for Blacks; HbA1c tests, foot exam, and eye exam were lower for Asians. In adjusted models, the only remaining disparities in quality of care indicators were HbA1c tests for Hispanics (AOR 0.67, CI = 0.47–0.97), Blacks (AOR 0.59, CI = 0.40–0.88), and Asians (AOR 0.47, CI = 0.42–0.99); foot exams for Hispanics (AOR 0.65, CI = 0.47–0.90); and flu vaccination for Blacks (AOR 0.68, CI = 0.49–0.93).

Conclusion

Lack of insurance coverage and education explained some of the racial/ethnic disparities observed in diabetes quality of care. Improving quality of diabetes care could help reduce rates of diabetes complications, healthcare costs, and mortality.
Literature
1.
Center for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014 [Internet]. GA: U.S. Department of Health and Human Services; 2014 p. 1–12. Available from: https://​www.​cdc.​gov/​diabetes/​pubs/​statsreport14/​national-diabetes-report-web.​pdf
2.
Forbes JM, Cooper ME. Mechanisms of diabetic complications. Physiol Rev. 2013;93:137–88.CrossRefPubMed
3.
Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, et al. US Renal Data System 2011 annual data report. Am J Kidney Dis. 2012;59:A7.CrossRefPubMed
4.
Zhang X, Saaddine JB, Chou C-F, Cotch MF, Cheng YJ, Geiss LS, et al. Prevalence of diabetic retinopathy in the United States, 2005–2008. JAMA J Am Med Assoc. 2010;304:649–56.CrossRef
5.
Chow EA, Foster H, Gonzalez V, McIver L. The disparate impact of diabetes on racial/ethnic minority populations. Clin Diabetes. 2012;30:130–3.CrossRef
6.
Vart P, Gansevoort RT, Coresh J, Reijneveld SA, Bültmann U. Socioeconomic measures and CKD in the United States and The Netherlands. Clin J Am Soc Nephrol CJASN. 2013;8:1685–93.CrossRefPubMed
7.
Nwanyanwu KH, Newman-Casey P-A, Gardner TW, Lim JI. Beyond HbA1c: environmental risk factors for diabetic retinopathy. J. Clin. Exp. Ophthalmol. [Internet]. 2015 [cited 2016 Sep 19];6. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pmc/​articles/​PMC4785841/​
8.
Clark ML, Utz SW. Social determinants of type 2 diabetes and health in the United States. World J Diabetes. 2014;5:296–304.CrossRefPubMedPubMedCentral
9.
Zheng H, George LK. Rising U.S. income inequality and the changing gradient of socioeconomic status on physical functioning and activity limitations, 1984–2007. Soc Sci Med. 2012;75:2170–82.CrossRefPubMed
10.
Montez JK, Zajacova A. Explaining the widening education gap in mortality among U.S. white women. J Health Soc Behav. 2013;54:166–82.CrossRefPubMedPubMedCentral
11.
Pampel FC, Krueger PM, Denney JT. Socioeconomic disparities in health behaviors. Annu Rev Sociol. 2010;36:349–70.CrossRefPubMedPubMedCentral
12.
O’Connor PJ, Bodkin NL, Fradkin J, Glasgow RE, Greenfield S, Gregg E, et al. Diabetes performance measures: current status and future directions. Diabetes Care. 2011;34:1651–9.CrossRefPubMedPubMedCentral
13.
Cooperberg MR, Birkmeyer JD, Litwin MS. Defining high quality health care. Urol Oncol. 2009;27:411–6.CrossRefPubMed
14.
Gregg EW, Li Y, Wang J, Burrows NR, Ali MK, Rolka D, et al. Changes in diabetes-related complications in the United States, 1990-2010. N Engl J Med. 2014;370:1514–23.CrossRefPubMed
15.
American Diabetes Association. Standards of medical care in diabetes. 2016;39:S1–2.
16.
American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care. 2013;36(Suppl 1):S11–66.CrossRef
17.
Laiteerapong N, Fairchild PC, Chou C-H, Chin MH, Huang ES. Revisiting disparities in quality of care among US adults with diabetes in the era of individualized care, NHANES 2007-2010. Med Care. 2015;53:25–31.CrossRefPubMedPubMedCentral
18.
Richard P, Alexandre PK, Lara A, Akamigbo AB. Racial and ethnic disparities in the quality of diabetes care in a nationally representative sample. Prev. Chronic. Dis. [Internet]. 2011;8. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pmc/​articles/​PMC3221581/​
19.
Pu J, Chewning B. Racial difference in diabetes preventive care. Res Soc Adm Pharm RSAP. 2013;9:790–6.CrossRef
20.
Hu R, Shi L, Rane S, Zhu J, Chen C-C. Insurance, racial/ethnic, SES-related disparities in quality of care among US adults with diabetes. J Immigr Minor Health Cent Minor Public Health. 2014;16:565–75.CrossRef
21.
Walker R, Strom W, Egede L. Influence of race, ethnicity and social determinants of health on diabetes outcomes. Am J Med Sci. 2016;35:366–73.CrossRef
22.
MEPS HC-163 2013 Full Year Consolidated Data File [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2015 p. 1–185. Available from: https://​meps.​ahrq.​gov/​data_​stats/​download_​data/​pufs/​h163/​h163doc.​pdf
23.
IBM SPSS Statistics Version 24.0. Armonk, NY: IBM Corporation; 2016.
24.
Healthy People 2020: Diabetes [Internet]. Office of Disease Prevention and Health Promotion; 2016 [cited 2016 Oct 5]. Available from: https://​www.​healthypeople.​gov/​2020/​topics-objectives/​topic/​diabetes/​objectives

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