Racial and Ethnic Differences in Health Care Access and Health Outcomes for Adults With Type 2 Diabetes

Abstract

OBJECTIVE -To evaluate health care access and utilization and health status and outcomes for type 2 diabetic patients according to race and ethnicity and to determine whether health status is influenced by health care access and utilization.RESEARCH DESIGN AND METHODS -National samples of Caucasians, AfricanAmericans, and Mexican-Americans were studied in the third National Health and Nutrition Examination Survey. Information on medical history and treatment of diabetes, health care access and utilization, and health status and outcomes was obtained by structured questionnaires and by clinical and laboratory assessments.RESULTS -Almost all patients in each race and ethnic group had one primary source of ambulatory medical care (92-97%), saw one physician at this source (83-92%), and had at least semiannual physician visits (83-90%). Almost all patients Ն65 years of age had health insurance (99 -100%), and for those patients Ͻ65 years of age, Caucasians (91%) and African-Americans (89%) had higher rates of coverage than Mexican-Americans (66%). Rates of treatment with insulin or oral agents (71-78%), eye examination in the previous year (61-70%), blood pressure check in the previous 6 months (83-89%), and the proportion of hypertension that was diagnosed (84 -91%) were similar for each race and ethnic group. Lower proportions of AfricanAmericans and Mexican-Americans self-monitored their blood glucose (insulin-treated, 27 vs. 44% of Caucasians), had their cholesterol checked (62-68 vs. 81%), and had their dyslipidemia diagnosed (45 vs. 58%). African-American and Mexican-American patients had a somewhat higher proportion than Caucasian patients, with HbA 1c Ն7% (58 -66 vs. 55%), blood pressure Ն140/90 mmHg among those with diagnosed hypertension (60 -65 vs. 55%), and clinical proteinuria (11-14 vs. 5%). In contrast, they had better levels of total cholesterol (Ն240 mg/dl) (28 -30 vs. 34%) and HDL cholesterol (Ն45 mg/dl) (46 -59 vs. 38%), and African-American and Mexican-American men were less overweight than Caucasian men (BMI Ն30) (34 -37 vs. 44%), although the opposite was true for women. LDL cholesterol levels and the proportion of patients who smoked cigarettes or were hospitalized in the past year were similar among all three groups. In logistic regression analysis, there was little evidence that levels of blood glucose, blood pressure, lipids, or albuminuria were associated with access to or utilization of health care or with socioeconomic status.CONCLUSIONS -There are some differences by race and ethnicity in health care access and utilization and in health status and outcomes for adults with type 2 diabetes. However, the magnitude of these differences pale in comparison with the suboptimal health status of all three race and ethnic groups relative to established treatment goals. Health status does not appear to be influenced by access to health care. Diabetes Care 24:454 -459, 2001

Diabetes Self-care among a Multiethnic Sample of Older Adults

“…The relatively limited use of unconventional approaches may strike some as surprising, given the greater likelihood of these four groups to have lower income and educational levels, less continuity of medical care, greater unmet medical needs, and lower rates of insurance coverage, (Harris 2001) factors that have been linked to both non-adherence to conventional self-care and to the use of alternative medical strategies for diabetes control. However, the predominance of and access to biomedicine may substitute for more culturally-specific diabetes control strategies (herbal approaches, complementary medicines) and may minimize cross cultural variation to diabetes self-care.…”

Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes: A Systematic Review and Meta-Analysis

“…1,2 There is great interest in developing and validating culturally sensitive approaches to improve diabetes care in underserved populations. Of particular interest are interventions to improve glycemic control, which is most often measured as a reduction in serum hemoglobin A1c levels (A1c, which reflects blood glucose levels over previous weeks).…”

Self-reported Neighborhood Safety and Nonadherence to Treatment Regimens Among Patients with Type 2 Diabetes

“…[1][2][3] Although income, education, communication barriers, insurance status and access to quality medical care are important contributors to these disparities, much of the observed variation in glycemic control remains unexplained by these factors. 4,5 This suggests that, even among individuals who have access to medical care, contextual influences-i.e. aspects of an individual's social and environmental life context that fall outside of the health care setting-may contribute to perpetuating health disparities.…”