Abstract P298: Racial Differences in Diabetes Care Practices: Prevalence and Determinants in Older Adults

Abstract

Background: The burden of complications among older adults with diabetes is high and disproportionately affects racial/ethnic minorities. Differences in diabetes care practices may be an important contributor to disparities. Our study examined whether engagement in diabetes care practices varies by race/ethnicity in older adults. Methods: We conducted a cross-sectional analysis of the prevalence of diabetes care practices using data from visit 6 (2016-2017) of the Atherosclerosis Risk in Communities (ARIC) study. Participants with previously diagnosed diabetes self-reported receipt of four annual examinations/tests (HbA1c testing, urine protein testing, eye examination, foot examination) and two types of vaccinations (influenza [annual], pneumonia [ever]). We assessed crude differences across race using chi-square tests. For care practices that differed significantly, we conducted a mediational analysis using logistic regression models to explore potential mechanisms. Results: Among the 886 participants with previously diagnosed diabetes (62% white, 58% female, mean age 79), the receipt of recommended annual tests or examinations (HbA1c and urine protein testing, eye and foot exams) was high (73%-94%) and did not differ significantly across race ( Figure ). In contrast, whites were more likely than blacks to have received vaccinations for influenza (83% versus 69%, P<0.001) and pneumonia (90% versus 73%, P<0.001), respectively ( Figure ). Differences in sociodemographic characteristics and health status explained ~52% and ~15% of the difference in influenza and pneumonia vaccinations, with household income emerging as the most important mediator for both outcomes. Conclusion: Engagement in diabetes care practices among older adults was high, but whites were more likely than blacks to receive recommended vaccinations. Ensuring vaccination coverage among racial/ethnic minorities with diabetes is important and may reduce disparities in development of complications.