Racial and Ethnic Disparities in Diabetes Care?

Steven Fox

October 20, 2011

October 20, 2011 — In contrast to findings from 2 recent trials suggesting improvement in quality of care for minority patients with diabetes, results from a study examining a nationally representative sample of people with diabetes indicate that racial and ethnic minority patients continue to receive lower-quality care than their white counterparts.

The study was conducted by Patrick Richard, PhD, from the Department of Health Policy, George Washington University School of Public Health and Health Services, Washington, DC, and colleagues and appears in the November issue of Preventing Chronic Disease.

The authors note that most previous studies have found that racial/ethnic minority patients with diabetes get lower-quality care than white patients, but a couple more recent studies have concluded that this disparity has narrowed.

"These inconsistencies suggest that additional investigation is needed to provide new information about the relationship between racial/ethnic minority patients and the quality of diabetes care," the authors write.

To advance that knowledge, investigators analyzed 3 years of data, from 2005 to 2007, on 2452 patients who reported they had been diagnosed with diabetes by a health professional. All patients were at least 18 years of age.

The data came from the Medical Expenditure Panel Survey, a nationally representative database of health services use, health insurance coverage, medical costs, and sources of payment for the noninstitutionalized US civilian population.

"We assessed racial/ethnic disparities in the quality of diabetes care on the basis of receipt of recommended HbA1c tests and foot and eye examinations in the previous year," the authors write.

They used multivariate statistical models to adjust for a wide variety of sociodemographic factors: age, sex, socioeconomic status, health behaviors (eg, whether people in the cohort were smokers), health status (eg, whether people in the cohort were obese), insurance status, comorbid cardiovascular conditions, and regional location.

The investigators report that more than 68% of patients were at least 55 years old, about a third resided in families with incomes more than 400% above the federally defined poverty level, and nearly a third were getting benefits from public insurance programs such as Medicare or Medicaid. More than three quarters of the participants had other cardiovascular conditions besides diabetes.

Overall, about 83% of the patients said they had received at least 2 HbA1c tests during the previous year. About 70% had received foot exams, and 61% had undergone eye examinations.

However, when racial/ethnics factors were taken into account, the researchers noted significant differences.

Asians were less likely than whites to have received at least 2 HbA1c tests (P = .007) or a foot exam (P = .002).

Patients who were Hispanic were less likely than whites to have had their eyes examined (P = .005).

Of note, black patients were more likely than white patients to have received a foot exam (P = .009), but they were less likely than whites to have had an eye exam (P = .03).

The authors point out that recent guidelines have stressed that black patients tend to have more complications and amputations from diabetes than whites do, and have highlighted the need to carefully monitor those patients.

In any case, the authors conclude, "[t]he differences in the quality of diabetes care remained significant even after controlling for socioeconomic status..., health insurance status, self-rated health status, comorbid conditions, and lifestyle behavior variables."

Why the differences in findings between this study and more recent studies? The authors cited several possible factors. For one, the investigators in the present study say they restricted their sample to unique individuals to compute appropriate standard errors in pooled estimations. They also used more recent data sets and employed several analytical methods recommended by the Medical Expenditure Panel Survey.

The authors also point out that the recent studies that came to different conclusions limited their patient cohort to Medicare beneficiaries enrolled in managed care programs, and that those studies did not stratify by other racial/ethnic minority groups such as Hispanics and Asians.

For that reason, the authors say, the previous findings may not be applicable to other health systems or to other racial/ethnic groups that may experience greater racial/ethnic disparities in the quality of diabetes care.

"Conversely," they conclude, "our findings are consistent with those of other studies that used both clinical and community-based data."

Limitations of the current study include its cross-sectional design, precluding conclusions about causality, and use of self-reported data for the dependent variables of diabetes care.

Prev Chronic Dis. 2011;8:A142. Full text

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