Racial differences in diabetes self-management and quality of care in Texas

Nwasuruba, Chiagozie; Osuagwu, Christie; Bae, Sejong; Singh, Karan P.; Egede, Leonard E.

doi:10.1016/j.jdiacomp.2007.11.005

« Previous Next »Journal of Diabetes and Its Complications
Volume 23, Issue 2 , Pages 112-118, March 2009

Racial differences in diabetes self-management and quality of care in Texas

Chiagozie Nwasuruba
- Department of Medicine, University of Texas Health Center at Tyler, TX, USA
Christie Osuagwu
- Department of Emergency Medicine, University of Texas Health Center at Tyler, TX, USA
Sejong Bae
- Department of Biostatistics, University of North Texas Health Science Center at Fort Worth, TX, USA
Karan P. Singh
- Department of Biostatistics, University of North Texas Health Science Center at Fort Worth, TX, USA
Leonard E. Egede
- Charleston VA TREP, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA
- Corresponding author. Medical University of South Carolina, Center for Health Disparities Research, 135 Rutledge Avenue, Room 280H, Charleston, SC 29425, USA. Tel.: +1 843 792 2969; fax: +1 843 876 1201.

Received 12 April 2007; received in revised form 8 October 2007; accepted 9 November 2007. published online 14 March 2008.

Abstract

Aim

To assess racial/ethnic differences in diabetes self-management behaviors and quality of care in Texas.

Methods

This cross-sectional study assessed self-management behaviors and quality of care in 1720 adults with diabetes in the 2002–2004 Texas Behavioral Risk Factor Surveillance Survey. Multiple logistic regression models were used for assessing the independent association between race/ethnicity, self-management behaviors, and quality of care variables controlling for covariates. SAS (SAS Institute Inc, 2002-2003) was used for statistical analysis.

Results

Eighteen percent of Hispanics, 14% of Blacks, and 10% of Whites reported never performing home glucose testing. Seventeen percent of Hispanics, 11% of Blacks, and 10% of Whites reported never doing home foot exam. Thirty-two percent of Hispanics, 21% of Blacks, and 16% of Whites did not have an A1C test in the prior 12 months. Twelve percent of Hispanics, 10% of Blacks, and 6% of Whites did not have a dilated eye exam in the prior 12 months. Fifty-four percent of Whites, 42% of Blacks, and 40% of Hispanics received a flu shot. Forty-nine percent of Whites, 30% of Blacks, and 26% of Hispanics received a pneumonia shot. In adjusted models, Hispanics were more likely to be sedentary (OR, 1.64; 95% CI, 1.08–2.49) compared to Whites. Blacks did not differ significantly from Whites (OR, 1.46; 95% CI, 0.92–2.34). Hispanics (OR, 1.61; 95% CI, 1.01–2.57) and Blacks (OR, 1.83; 95% CI, 1.10–3.03) were more likely to get an annual foot exam by a provider compared to Whites. Hispanics (OR, 0.54; 95% CI, 0.34–0.85) and Blacks (OR, 0.58; 95% CI, 0.35–0.98) were less likely to get a pneumonia shot compared to Whites.

Conclusions

Hispanics have poorer access to care and poorer health status compared to Whites or Blacks. Controlling for socioeconomic and access to care variables eliminated disparities in self-management but did not eliminate disparities in quality of diabetes care.

Keywords: Diabetes, Race, Ethnicity, Self-management, Survey research