HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Online-Only Appendix Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lanting, L. C. Articles by Bootsma, A. H. Search for Related Content PubMed PubMed Citation Articles by Lanting, L. C. Articles by Bootsma, A. H. Social Bookmarking                What's this?

Ethnic Differences in Mortality, End-Stage Complications, and Quality of Care Among Diabetic Patients

A review

¹ Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
² Department of Internal Medicine, University Medical Center, Rotterdam, the Netherlands

Address correspondence and reprint requests to Loes Lanting, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, Netherlands. E-mail: l.lanting{at}erasmusmc.nl

OBJECTIVE—To determine the influence of ethnic differences in diabetes care on inequalities in mortality and prevalence of end-stage complications among diabetic patients. The following questions were examined: 1) Are there ethnic differences among diabetic patients in mortality and end-stage complications and 2) are there ethnic differences among diabetic patients in quality of care?

RESEARCH DESIGN AND METHODS—A review of the literature on ethnic differences in the prevalence of complications and mortality among diabetic patients and in the quality of diabetes care was performed by systematically searching articles on Medline published from 1987 through October 2004.

RESULTS—A total of 51 studies were included, mainly conducted in the U.S. and the U.K. In general, after adjusting for confounders, diabetic patients from ethnic minorities had higher mortality rates and higher risk of diabetes complications. After additional adjustment for risk factors such as smoking, socioeconomic status, income, years of education, and BMI, in most instances ethnic differences disappear. Nevertheless, blacks and Hispanics in the U.S. and Asians in the U.K. have an increased risk of end-stage renal disease, and blacks and Hispanics in the U.S. have an increased risk of retinopathy. Intermediate outcomes of care were worse in blacks, and they were inclined to be worse in Hispanics. Likewise, ethnic differences in quality of care in the U.S. exist: process of care was worse in blacks.

CONCLUSIONS—Given the fact that there are ethnic differences in diabetes care and that ethnic differences in some diabetes complications persist after adjustment for risk factors other than diabetes care, it seems the case that ethnic differences in diabetes care contribute to the more adverse disease outcomes of diabetic patients from some ethnic minority groups. Although no generalizations can be made for all ethnic groups in all regions for all kinds of complications, the results do implicate the importance of quality of care in striving for equal health outcomes among ethnic minorities.

Abbreviations: ESRD, end-stage renal disease • LEA, lower-extremity amputation

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				B. R. Shah Utilization of physician services for diabetic patients from ethnic minorities J. Public Health Med., September 1, 2008; 30(3): 327 - 331. [Abstract] [Full Text] [PDF]

				K. E. Bainbridge, C. C. Cowie, K. F. Rust, and J. E. Fradkin Mitigating Case Mix Factors by Choice of Glycemic Control Performance Measure Threshold Diabetes Care, September 1, 2008; 31(9): 1754 - 1760. [Abstract] [Full Text] [PDF]

				M. K. Rhee, D. C. Ziemer, J. Caudle, P. Kolm, and L. S. Phillips Use of a Uniform Treatment Algorithm Abolishes Racial Disparities in Glycemic Control The Diabetes Educator, July 1, 2008; 34(4): 655 - 663. [Abstract] [Full Text] [PDF]

				H. Wagner, J. J. Pizzimenti, K. Daniel, N. Pandya, and P. C. Hardigan Eye on Diabetes: A Multidisciplinary Patient Education Intervention The Diabetes Educator, January 1, 2008; 34(1): 84 - 89. [Abstract] [Full Text] [PDF]

				D. Anderson and J. Christison-Lagay Diabetes Self-Management in a Community Health Center: Improving Health Behaviors and Clinical Outcomes for Underserved Patients Clin. Diabetes, January 1, 2008; 26(1): 22 - 27. [Full Text] [PDF]

				C. Millett, S. Saxena, A. Ng, A. Mainous III, and A. Majeed Socio-economic status, ethnicity and diabetes management: an analysis of time trends using the health survey for England J. Public Health Med., December 1, 2007; 29(4): 413 - 419. [Abstract] [Full Text] [PDF]

				M. E. Peek, A. Cargill, and E. S. Huang Diabetes Health Disparities: A Systematic Review of Health Care Interventions Med Care Res Rev, October 1, 2007; 64(5_suppl): 101S - 156S. [Abstract] [PDF]

				D. L. Burnet, A. J. Cooper, M. L. Drum, and R. B. Lipton Risk Factors for Mortality in a Diverse Cohort of Patients With Childhood-Onset Diabetes in Chicago Diabetes Care, October 1, 2007; 30(10): 2559 - 2563. [Abstract] [Full Text] [PDF]

				R. W. Grant Invited Commentary: Untangling the Web of Diabetes Causality in African Americans Am. J. Epidemiol., August 15, 2007; 166(4): 388 - 390. [Abstract] [Full Text] [PDF]

				S. Wolfram Effects of Green Tea and EGCG on Cardiovascular and Metabolic Health J. Am. Coll. Nutr., August 1, 2007; 26(4): 373S - 388S. [Abstract] [Full Text] [PDF]

				M. B. Davidson, A. Ansari, and V. J. Karlan Effect of a Nurse-Directed Diabetes Disease Management Program on Urgent Care/Emergency Room Visits and Hospitalizations in a Minority Population Diabetes Care, February 1, 2007; 30(2): 224 - 227. [Abstract] [Full Text] [PDF]