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© 2003 by the American Diabetes Association, Inc.
Epidemiology/Health Services/Psychosocial Research |
Ethnic and Racial Differences in Diabetes Care
The Insulin Resistance Atherosclerosis Study
1 Section on General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
2 Section on Social Sciences and Health Policy, Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
3 Section on Biostatistics, Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
4 Division of Research, Kaiser Permanente, Oakland, California
5 Division of Clinical Epidemiology, UCLA School of Medicine, Los Angeles, California
6 Section on Epidemiology, Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
OBJECTIVE—Diabetes and its complications disproportionately affect African Americans and Hispanics. Complications could be prevented with appropriate medical care. We compared five processes of care and three outcomes of care among African Americans, Hispanics, and non-Hispanic whites.
RESEARCH DESIGN AND METHODS—We used data from the Insulin Resistance Atherosclerosis Study (1993–1998) of participants with known diabetes. African Americans and Hispanics were compared with non-Hispanic whites from the same region. Five process measures (treatment of diabetes, hypertension, hyperlipidemia, albuminuria, and coronary artery disease) and three outcome measures (control of diabetes, hypertension, and hyperlipidemia) were evaluated.
RESULTS—Comparison groups were similar in baseline characteristics. African Americans and Hispanics were equally likely as their non-Hispanic white comparison group to receive treatment for diabetes, hypertension, hyperlipidemia, albuminuria, and coronary artery disease, although treatment rates for hyperlipidemia and albuminuria were poor for all groups. African Americans were more likely to have poorly controlled diabetes (HbA1c >8.0%: OR 2.23, 95% CI 1.26–3.94). Both African American and Hispanics were significantly more likely to have borderline or poorly controlled hypertension than non-Hispanic whites (blood pressure >130–140/85–90 or >140/90 mmHg: African American/non-Hispanic white OR 3.22, 95% CI 1.57–6.59; Hispanic/non-Hispanic white 3.14, 1.35–7.3).
CONCLUSIONS—The rates of treatment for diabetes and associated comorbidities are similar across all three ethnic groups. Few individuals in any ethnic group received treatment for hyperlipidemia and albuminuria. Ethnic disparities exist in control of diabetes and hypertension. Programs should be tested to improve overall quality of care and eliminate these disparities.
Abbreviations: IRAS, Insulin Resistance Atherosclerosis Study
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