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Racial/Ethnic Disparities in Diabetes Quality of Care: the Role of Healthcare Access and Socioeconomic Status

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Abstract

Introduction

Blacks, Hispanics, and Asians are disproportionately affected by diabetes. We assessed the state of racial/ethnic disparities in diabetes quality of care in the USA.

Methods

We analyzed cross-sectional data of adults diagnosed with Type 2 diabetes in the nationally representative 2013 Medical Expenditure Panel Survey. Differences in adherence to five diabetes quality of care recommendations (HbA1c twice yearly, yearly foot exam, dilated eye exam, blood cholesterol test, and flu vaccination) were examined by race/ethnicity while controlling for three social determinants of health (health insurance status, poverty, and education) and other demographic variables.

Results

Among adults with diabetes in the USA, 74.9% received two or more HbA1c tests, 69.0% had a foot exam, 64.9% had an eye exam, 85.4% had a cholesterol test, and 65.1% received flu vaccination in 2013. Compared to Whites, all were lower for Hispanics; HbA1c tests, eye exam, and flu vaccination were lower for Blacks; HbA1c tests, foot exam, and eye exam were lower for Asians. In adjusted models, the only remaining disparities in quality of care indicators were HbA1c tests for Hispanics (AOR 0.67, CI = 0.47–0.97), Blacks (AOR 0.59, CI = 0.40–0.88), and Asians (AOR 0.47, CI = 0.42–0.99); foot exams for Hispanics (AOR 0.65, CI = 0.47–0.90); and flu vaccination for Blacks (AOR 0.68, CI = 0.49–0.93).

Conclusion

Lack of insurance coverage and education explained some of the racial/ethnic disparities observed in diabetes quality of care. Improving quality of diabetes care could help reduce rates of diabetes complications, healthcare costs, and mortality.

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Acknowledgments

This research is supported by the Vanderbilt Institute for Clinical and Translational Research (VICTR), grant number UL1-TR000445.

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Authors and Affiliations

  1. Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA

    Juan R. Canedo, Mary K. Fadden & Maureen Sanderson

  2. Department of Surgery, Meharry Medical College, Nashville, TN, 37208, USA

    Stephania T. Miller

  3. Department of Psychology, Vanderbilt University, Nashville, TN, 37235, USA

    David Schlundt

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  1. Juan R. Canedo
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  2. Stephania T. Miller
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  3. David Schlundt
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  4. Mary K. Fadden
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Correspondence to Juan R. Canedo.

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Funding

This research is supported by the Vanderbilt Institute for Clinical and Translational Research (VICTR), grant number UL1-TR000445.

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The authors declare that they have no conflicts of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Canedo, J.R., Miller, S.T., Schlundt, D. et al. Racial/Ethnic Disparities in Diabetes Quality of Care: the Role of Healthcare Access and Socioeconomic Status. J. Racial and Ethnic Health Disparities 5, 7–14 (2018). https://doi.org/10.1007/s40615-016-0335-8

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  • DOI: https://doi.org/10.1007/s40615-016-0335-8

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