Abstract
BackgroundDiabetes mellitus has reached epidemic proportions in the United States. As the prevalence of diabetes continues to rise, the burden of disease is divided unevenly among different populations. Racial/ethnic disparities in diabetes care are pervasive, including the provision of care for prevention of complications. Prevention efforts should be focused on the time that immediately follows a diagnosis of diabetes. The aim of this study was to assess racial/ethnic differences in the receipt of guideline-directed diabetes care for complication prevention by individuals recently diagnosed with diabetes.MethodsWe used repeated cross-sections of individuals recently diagnosed with diabetes (within the past 5 years) from the National Health Interview Survey from 2011 to 2017. Multivariate regression was used to estimate the associations between race/ethnicity (non-Hispanic White, non-Hispanic Black and Hispanic) and guideline-directed process measures for prevention of diabetes complications (visits to an eye and foot specialist, and blood pressure and cholesterol checks by a health professional - each in the prior year). We assessed effect modification of these associations by socioeconomic status (SES).ResultsIn a sample of 7,341 participants, Hispanics had lower rates of having any insurance coverage (75.9 %) than Non-Hispanic Whites (93.2 %) and Blacks (88.1 %; p<0.001). After adjustment for demographics, total comorbidities, SES, and health insurance status, Hispanics were less likely to have an eye exam in the prior year (OR 0.80; (95 % CI 0.65-0.99); p=0.04) and a blood pressure check (OR 0.42; (95 % CI 0.28-0.65); p<0.001) compared to Non-Hispanic Whites. There was no significant effect modification of race/ethnicity by SES.ConclusionsHispanics recently diagnosed with diabetes were less likely to receive some indicators of guideline-directed care for the prevention of complications. Lack of insurance and SES may partially explain those differences. Future work should consider policy change and providers’ behaviors linked to racial/ethnic disparities in diabetes care.
Highlights
Diabetes mellitus has reached epidemic proportions in the United States
After adjustment for age, sex, oral diabetes medicine use, current insulin use, general health status, U.S region, marital status, body mass index (BMI), and number of comorbidities, Hispanics were less likely than White individuals to visit the eye doctor in the past year (Odds Ratio (OR) 0.65, 95 % Confidence Interval (CI) 0.54-0.79, p
Hispanics remained less likely to report visiting the eye doctor in the past year compared to Whites even after further adjusting for socioeconomic status (SES) and health insurance in Model 3
Summary
Diabetes mellitus has reached epidemic proportions in the United States. As the prevalence of diabetes continues to rise, the burden of disease is divided unevenly among different populations. Socioeconomic, biologic, clinical and health system factors rank among the causes for these differences.[3] The United States of America (U.S.) Centers for Disease Control and Prevention (CDC) estimates that in 2017-2018, the age-adjusted prevalence and incidence of diabetes in the United States was 12.5 % and 9.7 per 1,000 persons among Hispanics and 7.5 % and 5.0 per 1,000 persons among non-Hispanic Whites (hereafter called “Whites”).[1] Non-Hispanic Blacks (hereafter called “Blacks”) had a higher prevalence (11.7 %) and incidence (8.2 per 1,000 persons) compared to Whites These racial/ethnic differences in the incidence and prevalence rates of diabetes are mirrored by disparities in diabetes-related complications.[4] Blacks have 2.5-fold and Hispanics have 3-fold increased risk of retinopathy compared to Whites.[5, 6] there are conflicting studies on the association between race/ethnicity and risk of cardiovascular disease (CVD) among patients with diabetes,[7,8,9,10] Blacks and Hispanics have higher rates of risk factors of CVD; that is, hypertension, uncontrolled blood glucose and lipid profiles compared to White individuals.[11,12,13]
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