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Are there gender differences in diabetes care among elderly medicare enrolled veterans?

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Abstract

OBJECTIVE: To examine gender differences in diabetes care process measures and intermediate outcomes among veteran clinic users.

DESIGN: A retrospective cohort study using Veterans Health Administration (VHA) and Medicare files of VHA clinic users with diabetes. Diabetes care process measures were tests for hemoglobin A1c (HbA1c), low-density lipoprotein (LDL-C) values, and eye exams. Intermediate outcomes were HbA1c and LDL-C values below recommended thresholds. Chi-square tests and logistic regressions were used to assess gender differences.

PARTICIPANTS: Study population included 3,225 women and 231,922 men veterans with diabetes, enrolled in Medicare fee-for-service and alive at the end of fiscal year 2000.

RESULTS: Overall, there were no significant gender differences in HbA1c or LDL-C testing. However, women had higher rates in these process measures than men among the non-African American minorities. Women were more likely to have completed eye exams (odds ratio [OR]=1.11; 99% confidence interval [CI]=1.10, 1.23) but were less likely to have LDL-C under 130 mg/dL (OR=0.77; 99% CI=0.69, 0.87).

CONCLUSIONS: Among VHA patients with diabetes, clinically significant gender inequality was not apparent in most of diabetes care measures. However, there was evidence of better care among nonwhite and non-African American women than their male counterparts. Further research on interaction of race and gender on diabetes care is needed. This includes evaluation of integrated VHA women’s health programs as well as cultural issues. Lower LDL-C control among women suggests areas of unmet needs for women and opportunities for future targeted quality improvement interventions at system and provider levels.

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Author information

Authors and Affiliations

  1. Center for Health Care Knowledge and Management, VA New Jersey Health Care System, East Orange, NJ, USA

    Chin-Lin Tseng DrPH, Usha Sambamoorthi PhD, Mangala Rajan MBA, Anjali Tiwari MD, MS, Patricia Findley DrPH, MSW & Leonard Pogach MD, MBA

  2. University of Medicine and Dentistry-New Jersey Medical School, Newark, NJ, USA

    Chin-Lin Tseng DrPH, Anjali Tiwari MD, MS & Leonard Pogach MD, MBA

  3. Division of Health Care Systems and Policy, School of Public Health, University of Medicine and Dentistry-New Jersey Medical School, Piscataway, NJ, USA

    Usha Sambamoorthi PhD

  4. Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, CA, USA

    Susan Frayne MD, MPH

  5. Stanford University School of Medicine, Stanford, CA, USA

    Susan Frayne MD, MPH

  6. Program for Disability Research, Rutgers University, New Brunswick, NJ, USA

    Patricia Findley DrPH, MSW

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  1. Chin-Lin Tseng DrPH
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  2. Usha Sambamoorthi PhD
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  7. Leonard Pogach MD, MBA
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Correspondence to Chin-Lin Tseng DrPH.

Additional information

This research was supported partially by grant from the Veterans Affairs grant REA-03-021 and funding from the VA Diabetes QUERI Coordinating Center. The findings and opinions reported here are those of the authors and do not necessarily represent the views of the Veterans Health Administration or any other organizations.

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Tseng, CL., Sambamoorthi, U., Rajan, M. et al. Are there gender differences in diabetes care among elderly medicare enrolled veterans?. J GEN INTERN MED 21 (Suppl 3), S47–S53 (2006). https://doi.org/10.1111/j.1525-1497.2006.00374.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00374.x

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