Assessing Diabetes and Factors Associated with Foregoing Medical Care among Persons with Diabetes: Disparities Facing American Indian/Alaska Native, Black, Hispanic, Low Income, and Southern Adults in the U.S. (2011–2015)

Abstract

Objective: Identify individual- and place-based factors associated with diagnosed diabetes and forgone medical care among those diagnosed with diabetes. Background: Diabetes affects millions of individuals globally. In the U.S. alone the prevalence rate of diagnosed diabetes has more than doubled over the past 20 years (4.2% in 1994 to 10% in 2014). Methods: The Behavioral Risk Factor Surveillance System (2011–2015) was used to identify factors associated with self-reported diabetes diagnoses (ever diagnosed) among U.S. adults. Logistic regression modeled: (1) the likelihood of having diabetes; (2) the likelihood of forgone medical care among those with diabetes, given appropriate medical care has been linked to preventing complications associated with diabetes. Results: Rates of diabetes remained relatively stable from 2011 to 2015. The likelihood of diabetes was higher (p < 0.01) among racial and ethnic minority groups, men, those with lower incomes and those with lower education. Place-based disparities indicating a higher likelihood of having a diagnosis of diabetes were found for those living in rural areas (urban versus rural, unadjusted OR = 0.844–0.908; p < 0.01) and those living in the South (North, Midwest, and Western/Pacific regions versus the South, unadjusted OR = 0.794–0.889; p < 0.01). Similar results were found with forgone medical care among those diagnosed with diabetes being more likely in the South (North, Midwest, and Western/Pacific regions versus the South, unadjusted OR = 0.542–0.819). In fully-adjusted analyses, the prevalence of diabetes and forgone medical care among those diagnosed with diabetes was higher for those with lower incomes, from several racial/ethnic minority groups, and in the South versus most other regions. Conclusions: Identifying at-risk groups informs targets for prevention and assists efforts to address chronic disease self-management among those already diagnosed with diabetes.

What If Healthy Aging Is the ‘New Normal’?

“…Examining factors associated with those foregoing medical care due to cost barriers is important for improved intervention targeting and can help pinpoint strategies to bridge the gaps in access to care [ 21 ]. Similarly, identifying individual- and place-based characteristics associated with access to care for specific medical diagnoses in diverse populations can help identify risk groups (e.g., racial/ethnic adults, economically disadvantaged) and places (e.g., the South, rural areas) for the delivery of chronic disease self-management programs [ 22 ]. Meeting non-emergency medical transportation needs is a challenge for many older adults who no longer drive, but especially challenging for those living in rural areas who need essential medical services such as dialysis [ 23 ].…”

Impact of a community‐based approach to patient engagement in rural, low‐income adults with type 2 diabetes

“…The prevalence of diabetes is substantially higher in rural populations compared to urban populations (Towne et al, ). Diabetes is also more common among African‐Americans compared to non‐Hispanic whites (Centers for Disease Control and Prevention [CDC], ).…”

“…African‐Americans have a 1.5 higher risk of forgoing medical care due to cost compared to Whites, despite recent Medicaid expansion and health insurance reform efforts (Towne et al, ). Rural residents are also more likely than urban residents to delay seeking health care and to receive diabetes preventive health services (i.e., diagnostic tests [glucose, urinalysis, A1C, and blood pressure] or patient education [diet/nutrition, exercise, and stress management]), largely due to cost (Hale, Bennett, & Probst, ; Towne et al, ). Lack of engagement in diabetes preventive services may result in poor health outcomes (Hibbard & Greene, ).…”

Putting Self-Management in the Context of Community-Dwelling American Indians Living With Type 2 Diabetes

“…3 AIs are also more likely to forego medical care, particularly in relation to limiting care-seeking behaviors. 12 Within diabetes self-management education, care-seeking behavior relates to one’s capacity for problem solving 10 and self-monitoring. 13,14 Reasons for reduced care seeking include variable trust in their patient-provider relationships and the absence of specialty programs at the clinic or community level for diabetes.…”