Disparities in Diabetes Care Between Smokers and Nonsmokers
- Akiko S. Hosler, PHD12,
- Theresa M. Hinman, MPH1 and
- Harlan R. Juster, PHD1
- 1Bureau of Chronic Disease Epidemiology and Surveillance, New York State Department of Health, Albany, New York
- 2Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York
- Address correspondence and reprint requests to Akiko S. Hosler, PhD, Bureau of Chronic Disease Epidemiology and Surveillance, New York State Department of Health, 565 Corning Tower, ESP, Albany, NY 12237-0679. E-mail: ash05{at}health.state.ny.us
Smoking is a known risk factor for both macro- and microvascular complications of diabetes, contributing to higher medical costs, lower quality of life, and premature deaths in adults with diabetes who smoke (1–3). Although the prevalence of smoking has decreased over the last decade in the U.S., (4,5) one in six adults with diabetes still smokes (6). Diabetes experts recommend that diabetic smokers be advised about smoking cessation and closely monitored for signs of complications by health care professionals, (7) but diabetic smokers are reportedly less likely to receive the recommended care. A survey of health plan members reported that diabetic smokers were likely to have fewer diabetes care visits and receive less frequent preventive care than diabetic nonsmokers (8). Using data from community-based, statewide diabetes intervention programs, the present study compares five major diabetes care indicators between diabetic smokers and age-, sex-, and race-matched diabetic nonsmokers while controlling for the effects of insurance status.
RESEARCH DESIGN AND METHODS—
The data were collected from participants of the New York State Diabetes Coalitions community-based intervention programs, 1999–2004, which were designed to reach the medically underserved (9). All participants were required to complete standardized forms at program registration. The data contained self-reported health status, smoking behavior, diabetes care, and insurance status of >16,000 adults (aged ≥18 years) with diagnosed diabetes. Participants with <13 months of duration since diagnosis of diabetes were excluded from the study. Then, all current …
