Identifying State-Wide Health Disparities in Diabetes Mellitus Management in Arizona: Review of Healthy People 2020 Performance.

Katelyn Urban,Priya Radhakrishnan,Alethea Turner,Shiva Malaty

doi:10.7759/cureus.12993

Abstract

Healthy People (HP) 2020 is a national initiative focused on health promotion and disease prevention. Three state-wide metrics in Arizona were evaluated including diabetes-related death rate, biannual measurement of glycosylated hemoglobin (HA1c), and annual foot exam. The overall results of this review point to an alarming level of disparity that exists among Black patients for the three analyzed metrics. The American Indian population also experienced disproportionately high rates of diabetes-related death in Arizona. Additional variances were noted among uninsured patients and those who had received less than a high school degree. Identifying groups who are the most vulnerable to health inequity, investigating root cause, and addressing social determinants of health are critical to improving the health of our nation.

Highlights

Diabetes mellitus (DM) affects millions of Americans, and in Arizona there are more than 600,000 people diagnosed with the disease [1]
Effort to better understand why certain groups are more vulnerable than others, is necessary to reduce the significant burden that diabetes imposes on patients and the health care system
We examined the diabetes-related death rate per 100,000 [2] along with metrics that were directly related to provider-monitoring of diabetes progression: increasing the proportion of adults aged 18 years and over with diabetes who have a glycosylated hemoglobin (HA1c) measurement at least twice a year and who receive at least one annual foot examination [3,4]

Summary

Introduction

Diabetes mellitus (DM) affects millions of Americans, and in Arizona there are more than 600,000 people diagnosed with the disease [1]. Examination of racial disparities for this metric across the nation revealed that patients identifying as “Black or African American only” and “American Indian or Alaska Native only” had the two highest percentages of people meeting the target at 75.8% and 72.8%, respectively [4]. American Indian and Alaska Native people, who make up 5.3% of Arizona’s population, surpassed the national target for annual foot examinations (76.7%) and nearly reached the national goal for biannual HA1c measurements (72.9%). Despite this apparent success, American Indian and Alaska Native people in Arizona experience the highest rate in diabetes-related death when compared to other races [2]. Perspectives of those surveyed should be consistent between questions

Conclusions

Disclosures

Findings

Indian Health Service