Identifying racial/ethnic disparities in diabetes management in HRSA-supported health center patients

Background: Racial/ethnic minorities have higher risks for cardiovascular disease morbidity and mortality. This excess burden of morbidity and mortality may be attributable to uncontrolled diabetes and complications. HRSA-supported Health Centers (HC) care for over 19 million patients, 93% are below 200% poverty, and 63% are racial/ethnic minorities. Given HCs' patient population, HCs have the opportunity to reduce diabetes-related health disparities among America's most vulnerable populations.

Methods: Analyses of the 2009 Patient Survey – a nationally-representative sample of HC patients. For patients 18 years and older with diabetes (n=848), we estimated logistic regression models to examine racial/ethnic disparities in: 1) Process measures: a) eye exam in past year, b) foot exam in past year, and c) hemoglobin A1C test at least twice in past year; and 2) Intermediate outcome measures: a) frequency of high blood glucose and b) diabetes-related hospitalization or emergency department (ED) visit in past 2 years. Statistical models controlled for: age, gender, type of diabetes medication, diabetes care support receipt, health care access, and transportation.

Results: We did not find racial/ethnic disparities in: receipt of eye exam (p=0.816), receipt of A1C testing (p=0.637), high blood glucose levels (p=0.569), and diabetes-related hospitalization or ED visit (p=0.252), after controlling for confounders. In fact, Hispanic/Latino (OR: 1.58, 95% CI: 1.01, 2.47) and non-Hispanic African Americans (OR: 2.16, 95% CI: 1.39, 3.38) were more likely than non-Hispanic whites to have a foot exam in the past year. Having health insurance and a usual source of care increased the likelihood of having an eye exam (ORs: 2.52, 95% CI: 1.85, 3.44; 1.65, 95% CI: 1.08, 2.51) and foot exam (ORs: 1.78, 95% CI: 1.25, 2.54; 2.25, 95% CI: 1.32, 3.85). Reporting high blood glucose “Sometimes/Most of time/Always” was associated with increasing age. Men were more likely to have a diabetes-related ED visit or hospitalization (OR: 1.61, 95% CI: 1.08, 2.40). Conclusions: Health Centers are part of larger federal efforts to eliminate racial/ethnic health disparities. The finding that racial/ethnic minority patients did not appear to be disadvantaged in the diabetes measures studied indicates that HCs are making progress in this effort. Findings also suggest that health care access and diabetes education/support may increase preventive health care use (eye-, foot exam, and A1C test) and may reduce diabetic retinopathy and amputations across all racial/ethnic groups. Targeted and early interventions directed at men and older adults may help reduce the complications associated with diabetes.