Systematic review and meta‐analysis of patient race/ethnicity, socioeconomics, and quality for adult type 2 diabetes

Lee, Woolton; Lloyd, Jennifer; Giuriceo, Katherine; Day, Timothy; Shrank, William H.; Rajkumar, Rahul

doi:10.1111/1475-6773.13326

Cited by 24 publications

(14 citation statements)

References 69 publications

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“…People with unmet medical needs due to cost or without a usual source of care experience higher health costs and worse health outcomes, [37][38][39][40][41][42] and our findings indicate that these barriers are disproportionately more prevalent among racial and ethnic minorities.…”

Section: Discussionmentioning

confidence: 63%

“…In fact, the proportion of inadequately insured adults (i.e., those with out-of-pocket expenditures >10% of their household income, or >5% if they are part of a low-income family) increased after the ACA, 36 which could explain our findings. People with unmet medical needs due to cost or without a usual source of care experience higher health costs and worse health outcomes, 37-42 and our findings indicate that these barriers are disproportionately more prevalent among racial and ethnic minorities.…”

Section: Discussionmentioning

confidence: 65%

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Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999–2018

Caraballo

Massey

Mahajan

et al. 2020

Preprint

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Importance: Racial and ethnic disparities plague the US health care system despite efforts to eliminate them. To understand what has been achieved amid these efforts, a comprehensive study from the population perspective is needed. Objectives: To determine trends in rates and racial/ethnic disparities of key access to care measures among adults in the US in the last two decades. Design: Cross-sectional. Setting: Data from the National Health Interview Survey, 1999-2018. Participants: Individuals >18 years old. Exposure: Race and ethnicity: non-Hispanic Black, non-Hispanic Asian, non-Hispanic White, Hispanic. Main outcome and measures: Rates of lack of insurance coverage, lack of a usual source of care, and foregone/delayed medical care due to cost. We also estimated the gap between non-Hispanic White and the other subgroups for these outcomes. Results: We included 596,355 adults, of which 69.7% identified as White, 11.8% as Black, 4.7% as Asian, and 13.8% as Hispanic. The proportion uninsured and the rates of lacking a usual source of care remained stable across all 4 race/ethnicity subgroups up to 2009, while rates of foregone/delayed medical care due to cost increased. Between 2010 and 2015, the percentage of uninsured diminished for all, with the steepest reduction among Hispanics (-2.1% per year). In the same period, rates of no usual source of care declined only among Hispanics (-1.2% per year) while rates of foregone/delayed medical care due to cost decreased for all. No substantial changes were observed from 2016-2018 in any outcome across subgroups. Compared with 1999, in 2018 the rates of foregone/delayed medical care due to cost were higher for all (+3.1% among Whites, +3.1% among Blacks, +0.5% among Asians, and +2.2% among Hispanics) without significant change in gaps; rates of no usual source of care were not significantly different among Whites or Blacks but were lower among Hispanics (-4.9%) and Asians (-6.4%). Conclusions and Relevance: Insurance coverage increased for all, but millions of individuals remained uninsured or underinsured with increasing rates of unmet medical needs due to cost. Those identifying as non-Hispanic Black and Hispanic continue to experience more barriers to health care services compared with non-Hispanic White individuals.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 65%

Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999–2018

Caraballo

Massey

Mahajan

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…The prevalence and persistence of both mental illness and type 2 diabetes is associated with social determinants of health such as income, employment, migrant background and access to healthcare delivery 5,15 . Previous research examining the association between lower SES and healthcare delivery 16 produced mixed results, as any association is highly dependent on the specifics of local healthcare organisation 17,18 . A lower socio‐economic status (SES) is associated with poorer achievement of treatment targets for HbA 1c , SBP and lipids in people with diabetes 18,19 .…”

Section: Introductionmentioning

confidence: 99%

Achieving diabetes treatment targets in people with registered mental illness is similar or improved compared with those without: Analyses of linked observational datasets

et al. 2022

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Aims To determine the association between registered mental illness and type 2 diabetes mellitus treatment targets, while taking into account the effects of health expenditure and social determinants of health. Methods This observational cross‐sectional study was based on routine primary care data, linked to socio‐economic and medical claims data. The main outcomes, analysed by multivariate logistic regression, were achieving primary care guideline treatment targets for HbA1c, systolic blood pressure (SBP) and LDL‐cholesterol in 2017. We examined the association with diagnosed mental illness registered by the general practitioner (GP) or treated via specialist’ mental healthcare between 2016 and 2018, adjusting for, medication use, body mass index, co‐morbidity, smoking, and additionally examining effect‐modification of healthcare expenditures, migration status, income and demographics. Results Overall (N = 2862), 64.0% of participants achieved their treatment targets for HbA1c, 65.1% for SBP and 53.0% for LDL‐cholesterol. Adjusted for migrant background, income and care expenditures, individuals <65 years of age with mental illness achieved their HbA1c treatment target more often than those without (OR (95% CI)): treatment by GP: 1.46 (1.01, 2.11), specialist care: 1.61 (1.11, 2.34), as did men with mental illness for SBP: GP OR 1.61 (1.09, 2.40), specialist care OR 1.59 (1.09, 2.45). LDL‐cholesterol target was not associated with mental illness. A migrant background or low income lowered the likelihood of reaching HbA1c targets. Conclusions People with registered mental illness appear comparable or better able to achieve diabetes treatment targets than those without. Achieving HbA1c targets is influenced by social disadvantage.

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“…Diabetes disproportionally burdens racial/ethnic minority groups [ 38 , 39 , 40 , 41 ]. Prior research found home health care services were underutilized by AAPI patients [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity

Smith

Lin

Thomas‐Hawkins

et al. 2021

IJERPH

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Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015. Of these patients, 26.6% were discharged to home health care. To evaluate the association between timing of home health care initiation and 30-day rehospitalizations, multivariate logistic regression models including patient demographics, clinical and geographic variables, and neighborhood socioeconomic variables were used. Inverse probability-weighted propensity scores were incorporated into the analysis to account for potential confounding between the timing of home health care initiation and the outcome in the cohort. Compared to the patients who received home health care within the recommended first two days, the patients who received delayed services (3–7 days after discharge) had higher odds of rehospitalization (OR, 1.28; 95% CI, 1.25–1.32). Among the patients who received late services (8–14 days after discharge), the odds of rehospitalization were four times greater than among the patients receiving services within two days (OR, 4.12; 95% CI, 3.97–4.28). Timely initiation of home health care following diabetes-related hospitalizations is one strategy to improve outcomes.

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Systematic review and meta‐analysis of patient race/ethnicity, socioeconomics, and quality for adult type 2 diabetes

Abstract: Objective: To review the evidence of the association between performance in eight indicators of diabetes care and a patient's race/ethnicity and socioeconomic characteristics.

Cited by 24 publications

References 69 publications

Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999–2018

Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999–2018

Achieving diabetes treatment targets in people with registered mental illness is similar or improved compared with those without: Analyses of linked observational datasets

Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity

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