Diabetes‐related inequalities in health status and financial barriers to health care access in a population‐based study

Gulliford, Martin; Mahabir, D; Rocke, Brian

doi:10.1046/j.1464-5491.2003.01061.x

Cited by 20 publications

(17 citation statements)

References 38 publications

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“…Among the studies reviewed we found that the prevalence of diabetes was higher among persons with lower incomes and lower educational attainment. This trend in the prevalence of diabetes was similar across the Caribbean [18,36]. …”

Section: Resultsmentioning

confidence: 84%

“…Whites vs. South AsiansUnited KingdomCommunity clinic settingNo limitations stated.Male: 184Female: 87AgeType unspecifiedGulliford, 1997 [33]Cross-sectional study1,149Afro-Trinidadian vs. Indo-TrinidadianTrinidad and TobagoHospital basedEvidence of selection bias with more ill patients less likely to provide interview data.Male: 454Female: 695Age >15yDM unspecifiedGulliford, 1998 [34]Cross-sectional study622Afro-Trinidadian vs. Indo-TrinidadianTrinidad and TobagoHealth centerSample biased to socially less advantage individuals.Male: 204Female: 418DM type 2Gulliford, 2001 [35]Cross-sectional study2,117Afro-Trinidadian vs. Indo-TrinidadianTrinidad and TobagoGovernment health centresLarge geographically representative sample. Reporting bias; over-reporting of private utilization in older age group.Male: 633Female: 1484DM unspecifiedGulliford, 2004 [36]Cross-sectional study548Indo Trinidadian vs. Afro Trinidadian vs. mixed TrinidadianTrinidad and TobagoPopulation based community studyHigher non-response among affluent groups. Appreciable risk of type II error in findings among men.Male: 250Female: 298Age >25DM type 2Gulliford, 2010 [37]Cross-sectional study31,484Afro-Caribbean vs.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, the prevalence of diabetes increased with age across all ethnic groups and social indicators [18,28,36,54]. In age groups < 35 the prevalence was ~2% and in those >65 years it ranged between 10 and 16%.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven papers investigated the sex differences in the prevalence of diabetes [18,23,25,28-30,34,36,42,44,54], of which 6 noted a higher prevalence among women compared to men which ranged between 9.3 - 14% vs. 6.4-9.8% respectively [23,28-30,36,54]. One study evaluated the burden of diabetes among immigrants in Canada and reported higher prevalence of newly diagnosed diabetes among men (10.0%) compared to women (9.3%) [25].…”

Section: Resultsmentioning

confidence: 99%

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Disparities in diabetes mellitus among Caribbean populations: a scoping review

Bennett

Francis

Ferguson

et al. 2015

Int J Equity Health

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BackgroundDespite the large body of research on racial/ethnic disparities in health, there are limited data on health disparities in Caribbean origin populations. This review aims to analyze and synthesize published literature on the disparities in diabetes mellitus (DM) and its complications among Afro-Caribbean populations.MethodsA detailed protocol, including a comprehensive search strategy, was developed and used to identify potentially relevant studies. Identified studies were then screened for eligibility using pre-specified inclusion and exclusion criteria. An extraction form was developed to chart data and collate study characteristics including methods and main findings. Charted information was tagged by disparity indicators and thematic analysis performed. Disparity indicators evaluated include ethnicity, sex, age, socioeconomic status, disability and geographic location. Gaps in the literature were identified and extrapolated into a gap map.ResultsA total of 1009 diabetes related articles/manuscripts, published between 1972 and 2013, were identified and screened. Forty-three studies met inclusion criteria for detailed analysis. Most studies were conducted in the United Kingdom, Trinidad and Tobago and Jamaica, and used a cross-sectional study design. Overall, studies reported a higher prevalence of DM among Caribbean Blacks compared to West African Blacks and Caucasians but lower when compared to South Asian origin groups. Morbidity from diabetes-related complications was highest in persons with low socioeconomic status. Gap analysis showed limited research data reporting diabetes incidence by sex and socioeconomic status. No published literature was found on disability status or sexual orientation as it relates to diabetes burden or complications. Prevalence and morbidity were the most frequently reported outcomes.ConclusionLiterature on diabetes health disparities in Caribbean origin populations is limited. Future research should address these knowledge gaps and develop approaches to reduce them.

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Section: Resultsmentioning

confidence: 84%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Disparities in diabetes mellitus among Caribbean populations: a scoping review

Bennett

Francis

Ferguson

et al. 2015

Int J Equity Health

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show abstract

“…1 In addition, low income and lack of health insurance are associated with worse health status among patients with diabetes. 5 Traditional approaches to diabetes education and long-term chronic disease management have been less effective when applied to the most vulnerable segments of the diabetes population than when applied to other segments. [6][7][8] Culturally appropriate educational and management strategies to address the specific needs of underserved Hispanic populations have been developed and implemented in multiple locations in the United States.…”

mentioning

confidence: 99%

Effectiveness of a Community Health Worker as Sole Diabetes Educator: Comparison of CoDE with Similar Culturally Appropriate Interventions

Culica

Walton²,

Harker³

et al. 2008

hpu

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The feasibility of a newly designed Community Diabetes Education (CoDE) intervention was evaluated in preparation for the development of a pilot study of this program. A comparison between CoDE and similar culturally appropriate diabetes management programs developed specifically for Hispanic Americans demonstrates its unique features. Patient insurance status, duration of the intervention, delivery in individual and/or group settings, the characteristics of the diabetes educator(s), the other professional resources involved in these interventions, the associated costs, and the reported health outcomes were used in the comparison. The significant improvement in hemoglobin A1c observed in patients who completed one year of CoDE suggests that a community health worker can serve as the primary patient educator in the absence of more highly educated personnel required by American Diabetes Association–certified diabetes education programs. This low-cost model can be reproduced de novo in community health centers or inserted into existing diabetes management interventions.

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Cancer screening and the periodic health examination

Smith

Wender

2004

Cancer

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In this issue of Cancer, investigators from the Taiwan Communitybased Integrated Screening Group report outcomes from an integrated model of multiphasic chronic disease screening in Keelung, Taiwan.1 Their findings represent an important, modern demonstration of a practical and productive approach to preventive health and case finding. The design and outcomes of the Keelung Communitybased Integrated Screening (KCIS) program are noteworthy for several reasons and should reopen the debate not only about the worth, but also the protocol of periodic preventive health examinations.The underlying philosophy of the KCIS program was the potential for the simultaneous ascertainment of two or more asymptomatic chronic conditions, identification of multiple risk factors for metabolic syndrome, enhanced attendance for screening, and more efficient use of resources. Other "linkage" strategies might be equally effective, or be more appropriate for other target audiences. The program focused on five neoplasms (breast, cervical, colorectal, liver, and oral cancers) and three nonneoplastic chronic conditions (diabetes, hypertension, and elevated cholesterol), and education concerning metabolic syndrome. The decision to use the Papanicolaou (Pap) smear registry as a base to build the program was both innovative and practical because screening for cervical cancer is well established and because women can play a pivotal role in monitoring and attending to the health status of other family members. The investigators increased adherence in nonattenders to the Pap smear program by incorporating cervical cancer screening into a broader testing regimen, thus increasing the screening rate in nonattenders who may have been averse to gynecologic screening, with incentives for additional preventive care opportunities for themselves and other family members. Telephone invitations to 30,384 women resulted in 42,387 participants (24,469 women and 17,918 dependents) being seen at 257 health centers. The program increased adherence to cervical cancer screening by 25% (from 55.5% to 80.5%). For all cancer screening, the overall detection of asymptomatic neoplasia was 16 per 1000. Significant numbers of individuals with previously unknown diabetes, metabolic syndrome, hyperlipidemia, and hypertension also were identified. Based on these findings, the investigators estimated that 959 deaths will be averted over a 10-year period after full imple- 1553

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Diabetes‐related inequalities in health status and financial barriers to health care access in a population‐based study

Cited by 20 publications

References 38 publications

Disparities in diabetes mellitus among Caribbean populations: a scoping review

Disparities in diabetes mellitus among Caribbean populations: a scoping review

Effectiveness of a Community Health Worker as Sole Diabetes Educator: Comparison of CoDE with Similar Culturally Appropriate Interventions

Cancer screening and the periodic health examination

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