Socio-demographic predictors of adherence to A1C test among diabetics, Texas

Background: One of the Healthy People (2020) goals related to the HbA1C test aims to increase the percentage of adults aged 18 years and older with diagnosed diabetes who had a glycosylated hemoglobin measurement at least twice in the past 12 months from 64.6 percent in 2008 to 71.7 percent by 2020. The Texas rate for the two measurements in the past 12 months was about 60% in 2012 as per Behavioral Risk Factor Surveillance System (BRFSS) data. Given that gap, this study examines the socio-demographic predictors of adherence of the A1C test among diabetics.

Method: Texas BRFSS data (2011 and 2012) were used to predict adherence to A1C test in the past 12 months among diabetics. Examined socio-demographic predictors were age, sex, race / ethnicity, marital status, educational attainment, insurance status (as a proxy of income), and age when diabetes was diagnosed. A logistic model was developed to predict the membership. Significant variables in the univariate analysis were included in the logistic model.

Results: Mean age of those who were not adherent was 51.3 years compared to 58.7 years of those who were adherent. Mean age of diabetes diagnosis also differed among two groups; 43.0 years for non-adherent and 49.7 years for adherent. Univariate analysis indicated that race/ethnicity, educational attainment, marital status, insurance status and age at the diagnosis of diabetes could independently predict the adherence to an annual A1C test. Multivariate logistic regression indicated that insurance status and educational attainment are predictors of adherence to an annual A1C test. Those with insurance were nearly three times likely to report adherence to annual A1C test [OR=2.82, 95% CI, 1.47 – 5.42, p=0.002] than those without insurance, when controlled for all other socio-demographic variables. Likewise, those with more than college level education were also nearly three times likely to report adherence [OR=2.74, 95% CI, 1.27 – 5.89, p=0.010] than those with less than high school level education.

Conclusion: Population based diabetes management programs should consider educational attainment level and insurance status of individuals when developing interventions to increase rate of adherence to A1C test. Targeting interventions towards individuals with less than high school education and ensuring that diabetic individuals have health insurance coverage can be helpful.