Ethnic Differences in Mortality, End-Stage Complications, and Quality of Care Among Diabetic Patients

Abstract

OBJECTIVE -To determine the influence of ethnic differences in diabetes care on inequalities in mortality and prevalence of end-stage complications among diabetic patients. The following questions were examined: 1) Are there ethnic differences among diabetic patients in mortality and end-stage complications and 2) are there ethnic differences among diabetic patients in quality of care?RESEARCH DESIGN AND METHODS -A review of the literature on ethnic differences in the prevalence of complications and mortality among diabetic patients and in the quality of diabetes care was performed by systematically searching articles on Medline published from 1987 through October 2004.RESULTS -A total of 51 studies were included, mainly conducted in the U.S. and the U.K. In general, after adjusting for confounders, diabetic patients from ethnic minorities had higher mortality rates and higher risk of diabetes complications. After additional adjustment for risk factors such as smoking, socioeconomic status, income, years of education, and BMI, in most instances ethnic differences disappear. Nevertheless, blacks and Hispanics in the U.S. and Asians in the U.K. have an increased risk of end-stage renal disease, and blacks and Hispanics in the U.S. have an increased risk of retinopathy. Intermediate outcomes of care were worse in blacks, and they were inclined to be worse in Hispanics. Likewise, ethnic differences in quality of care in the U.S. exist: process of care was worse in blacks.CONCLUSIONS -Given the fact that there are ethnic differences in diabetes care and that ethnic differences in some diabetes complications persist after adjustment for risk factors other than diabetes care, it seems the case that ethnic differences in diabetes care contribute to the more adverse disease outcomes of diabetic patients from some ethnic minority groups. Although no generalizations can be made for all ethnic groups in all regions for all kinds of complications, the results do implicate the importance of quality of care in striving for equal health outcomes among ethnic minorities. Diabetes Care 28:2280 -2288, 2005D iabetes is one of the most common chronic diseases in Europe and the U.S. (1-3). Diabetes is divided into etiologic subclasses, of which type 1 and type 2 are the most prevalent (4). The prevalence of type 1 and, in particular, type 2 diabetes is rising in all European countries (2). Type 2 diabetes is the major contributor to the epidemic rise in diabetes because this type accounts for Ͼ90% of diabetes. In the U.S., the overall prevalence of diabetes increased from 4.9% in 1990 to 6.5% in 1998 (5). There is a parallel rise in the prevalence of complications related to diabetes.The prevalence of diabetes varies, among other factors, by ethnicity. Several studies (3,6,7) on ethnic differences in diabetes have reported higher prevalence and incidence rates among ethnic minorities. Furthermore, end-stage complications of diabetes have been reported to be more common among ethnic minorities (8 -10), who also experience higher morta...

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