Original Research
Racial difference in diabetes preventive care

https://doi.org/10.1016/j.sapharm.2012.11.005Get rights and content

Abstract

Background

Diabetes has long been a leading cause of death in the United States, and worldwide. Diabetes-related preventive services are recommended to delay or to avoid diabetes complications. Racial disparity in the receipt of diabetes preventive care is well documented; however, little is known about the contributors to this disparity.

Objective

This study aims to explore potential mediators linking race/ethnic disparities to reduced receipt of preventive care, and to better understand the dynamics underlying the relationships between race/ethnic characteristics and preventive care. Implications for pharmacist roles are explored.

Methods

This study used 2008 Medical Expenditure Panel Survey (MEPS) data. The outcome of diabetes preventive care was assessed by participants' self-reports in MEPS. Household income and health insurance coverage were identified as potential mediators based on Andersen's Health Care Utilization Behavior model. Logistic regression was used to examine the direct effects of study independent variables on diabetes preventive care. Path analysis was conducted to identify racial disparities' direct and indirect effects on diabetes preventive care via potential mediators. All estimates were weighted to the U.S. non-institutionalized population.

Results

Racial differences occurred with respect to receiving A1C tests, diabetic foot exams, and eye exams. After controlling for patient age, gender, living area, income, and health insurance status, racial differences persisted in diabetes preventive care. Hispanics were the least likely to receive all three elements of diabetes preventive care. In addition, patients were less likely to receive diabetes preventive care who were younger, lived in rural areas, had lower family income and were uninsured. A lower rate of diabetes preventive care in minority patients was partially explained by their higher rate of being uninsured or having low family income.

Conclusion

The results suggest that minority, rural, low-income, uninsured, and young diabetes patients are at a higher risk of not receiving diabetes preventive care. This study is unique in its use of path analysis to assess racial disparities in diabetes preventive care and to do so drawing on Andersen's Health Care Utilization Behavior model. In response to the disparity findings which were reinforced in this study, pharmacists have a need and an opportunity to help identify and address important gaps in diabetes preventive care through diabetes patient assessment, education, referral, and monitoring.

Section snippets

Background

According to the American Diabetes Association (ADA), 8.3% of the United States total population had diabetes in 2011.1 In 2006, diabetes was the seventh leading cause of death in the United States.2 Disparities in diabetes are well documented. A national survey in 2004–2006 found that there is a high prevalence of diabetes in non-Hispanic black/African Americans (11.8%), and in Hispanics (10.4%).3 There are enormous economic costs associated with diabetes and its secondary complications,

Methods

Data for this analysis were obtained from the 2008 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of non-institutionalized U.S. residents sponsored by the Agency for Healthcare Research and Quality (AHRQ) and the National Center for Health Statistics (NCHS). The data set was chosen because of its sample size, racial composition, national sample, and set of variables hypothesized to influence the receipt of diabetes preventive care based on the Andersen model. The

Results

Table 1 shows the sample characteristics for adult diabetes patients. About 69% of the sample patients were non-Hispanic white, 15% were Hispanic, and 16% were African American. The mean patient age was 60 years, 50% were female, 82% lived in metropolitan area, 47% had an annual income of $44,361 or above, and 8% had no health insurance. Seventy four percent of these patients received an A1C test at least twice in the past year, 65% received a diabetic foot exam in the past year, and 63%

Discussion

To the authors' best knowledge, this is the first study to use path analysis to assess racial disparity in diabetes preventive care using the Andersen model. Using a national representative sample this study found that there is a racial difference in obtaining diabetes preventive care in terms of getting at least two A1C tests, a diabetic foot exam, and an eye exam. Compared to their white peers, African Americans were less likely to receive these elements of preventive care, while Hispanics

Conclusion

In conclusion, this study suggests that minority, rural, low-income, uninsured, and young diabetes patients are at a higher risk of not receiving diabetes preventive care. To the authors' best knowledge, this is the first study to use path analysis to assess racial disparity in diabetes preventive care and to do so drawing on the Andersen's Health Care Utilization Behavior model. In response to the disparity findings reinforced in this study, pharmacists have a need and an opportunity to help

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  • Cited by (71)

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      Previous reports have found that diabetes is more prevalent among adults with less than a high school or high school education as compared to those with more than a high school education (Centers for Disease Control and Prevention. Diabetes Report Card, 2017; Borrell et al., 2006). Additionally, having some form of health insurance was associated with higher odds of receiving all of the preventive practices collectively, which is consistent with prior research (Pu and Chewning, 2013; Tran et al., 2017; Centers for Disease Control and Prevention, 2005). However, adults with private insurance were more likely to receive all the recommended preventative measures as compared to those with public insurance among all adults with diabetes and all subgroups.

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