Race, Ethnicity, Socioeconomic Position, and Quality of Care for Adults With Diabetes Enrolled in Managed Care

The Translating Research Into Action for Diabetes (TRIAD) study

  1. Arleen F. Brown, MD, PHD1,
  2. Edward W. Gregg, PHD2,
  3. Mark R. Stevens, MSPH, MA2,
  4. Andrew J. Karter, PHD3,
  5. Morris Weinberger, PHD45,
  6. Monika M. Safford, MD6,
  7. Tiffany L. Gary, PHD7,
  8. Dorothy A. Caputo, APRN, BC-ADM8,
  9. Beth Waitzfelder, PHD9,
  10. Catherine Kim, MD, MPH10 and
  11. Gloria L. Beckles, MD, MSC2
  1. 1Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
  2. 2Centers for Disease Control and Prevention, Atlanta, Georgia
  3. 3Division of Research, Kaiser Permanente, Oakland, California
  4. 4Department of Health Policy and Administration, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
  5. 5Center for Health Services Research in Primary Care, Durham VAMC, Durham, North Carolina
  6. 6Deep South Center on Effectiveness at Birmingham VA Medical Center and Department of Preventive Medicine University of Alabama at Birmingham, Birmingham, Alabama
  7. 7Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
  8. 8University of Medicine and Dentistry of New Jersey Continuing and Outreach Education, New Brunswick, New Jersey
  9. 9Pacific Health Research Institute, Honolulu, Hawaii
  10. 10Departments of Medicine and Obstetrics-Gynecology, University of Michigan, Ann Arbor, Michigan
  1. Address correspondence and reprint requests to Arleen F. Brown, MD, PhD, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1736. E-mail: abrown{at}


OBJECTIVE—To examine racial/ethnic and socioeconomic variation in diabetes care in managed-care settings.

RESEARCH DESIGN AND METHODS—We studied 7,456 adults enrolled in health plans participating in the Translating Research Into Action for Diabetes study, a six-center cohort study of diabetes in managed care. Cross-sectional analyses using hierarchical regression models assessed processes of care (HbA1c [A1C], lipid, and proteinuria assessment; foot and dilated eye examinations; use or advice to use aspirin; and influenza vaccination) and intermediate health outcomes (A1C, LDL, and blood pressure control).

RESULTS—Most quality indicators and intermediate outcomes were comparable across race/ethnicity and socioeconomic position (SEP). Latinos and Asians/Pacific Islanders had similar or better processes and intermediate outcomes than whites with the exception of slightly higher A1C levels. Compared with whites, African Americans had lower rates of A1C and LDL measurement and influenza vaccination, higher rates of foot and dilated eye examinations, and the poorest blood pressure and lipid control. The main SEP difference was lower rates of dilated eye examinations among poorer and less educated individuals. In almost all instances, racial/ethnic minorities or low SEP participants with poor glycemic, blood pressure, and lipid control received similar or more appropriate intensification of therapy relative to whites or those with higher SEP.

CONCLUSIONS—In these managed-care settings, minority race/ethnicity was not consistently associated with worse processes or outcomes, and not all differences favored whites. The only notable SEP disparity was in rates of dilated eye examinations. Social disparities in health may be reduced in managed-care settings.


  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted September 1, 2005.
    • Received May 19, 2005.
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