Numbers Don't Lie, but Do They Tell the Whole Story?
- Dean Schillinger, MD1,2,3 and
- Urmimala Sarkar, MD, MPH1,2
- 1Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco, San Francisco, California;
- 2Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California;
- 3California Diabetes Program, California Department of Public Health, Sacramento, California.
- Corresponding author: Dean Schillinger, dschillinger{at}medsfgh.ucsf.edu.
Newly appointed Secretary of the U.S. Department of Health and Human Services, Kathleen Sebelius, recently reaffirmed that reducing social disparities in diabetes is a national priority (1). Lower educational attainment has been strongly linked to higher diabetes prevalence and worse diabetes control. In California, for example, diabetes is much more common among those with a 9th grade education or less (14%) compared with those with a college degree or higher (5%). Nationally, very large disparities in diabetes-related mortality also exist across education levels, with rates three- to fivefold higher among those with less than a high school degree versus a college degree. Educational disparities in both diabetes control (as measured by A1C) and mortality have widened over the last 20 years (2). Similarly, many racial and ethnic minority groups have higher diabetes prevalence and worse diabetes control. African Americans are much more likely than non-Hispanic white to have diabetes and to experience worse glycemic control, even in populations with similar access to care (3). Insofar as African Americans are less likely than non-Hispanic white to have received the benefits of higher education, understanding whether lower educational attainment is an explanatory factor for racial and ethnic disparities in diabetes is critical for practitioners and policy makers in public health and clinical medicine.
It is in that spirit that Osborn et al. (4) have asked the question, “Can an assessment of performance strongly related to educational attainment (numeracy) help explain observed racial disparities in disease control, in a disease (diabetes) whose management demands a certain facility with numbers?” Prior research in a sample of ethnically diverse, …
