195776 A Life-course, mixed method analysis of race/ethnicity and diabetic outcomes of older adults

Sunday, November 8, 2009

Emily Joy Nicklett, MSW , Health Management and Policy, University of Michigan, Ann Arbor, MI

We examined disparities in health outcomes by race/ethnicity among older adults with type 2 diabetes. Using trajectory analysis, we aimed to (1) determine health decline by race/ethnicity; and (2) examine correlates proposed previously in cross-sectional research, such as discrimination, insurance trajectories and health behaviors/adherence to the diabetic regimen.


Using group-based trajectory analysis, we examined trajectories 14-year Health and Retirement Study data (n=1903) on health outcomes (self-reported global measure and ADLs/IADLs) with three measures of by race and ethnicity (whites, blacks, Latinos, and Asian Americans). We triangulated qualitative and life history calendar data from a small, community-based sample of older adults with diabetes (n=30) to expound upon different trajectory shapes by race/ethnicity, as well as to examine the mechanisms underlying the relationship between race/ethnicity and transitional health outcomes.


Race/ethnicity was associated with sharper rates of health decline among diabetics (p<.05). For example, Hispanics having a 55.5% reduced probability of better health than whites, compared to 54% for Blacks. Qualitative data confirmed these findings and preliminary analysis suggests that insurance status and health behavior/regimen adherence explains a portion of this difference, early life conditions, exposure to stressful life circumstances, and less favorable experiences with the health system, each arise as themes related to sharper decline in health.


This study identifies important areas for intervention to prevent rapid decline in health status among diabetics. More attention—in research and policy—is needed to address these disparities as the population ages and chronic illnesses such as diabetes become increasingly prevalent.

Learning Objectives:
1. Examine the extent to which race/ethnicity is associated with health outcomes among older adults with type 2 diabetes. 2. Identify specific subgroups that are at relatively high risk for health decline. This will enable interventions to be most appropriately and efficiently targeted to groups in highest need. 3. Determine which of the mixed-methodological strategies promote understanding regarding fundamental causes for health decline.

Keywords: Chronic Illness, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conceived of the research as part of my dissertation, collected and analyzed data, and was the primary author in charge of preparing the manuscript.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.