Racial and Ethnic Differences in Health Care Access and Health Outcomes for Adults With Type 2 Diabetes

Abstract

OBJECTIVE—To evaluate health care access and utilization and health status and outcomes for type 2 diabetic patients according to race and ethnicity and to determine whether health status is influenced by health care access and utilization. RESEARCH DESIGN AND METHODS—National samples of Caucasians, African-Americans, and Mexican-Americans were studied in the third National Health and Nutrition Examination Survey. Information on medical history and treatment of diabetes, health care access and utilization, and health status and outcomes was obtained by structured questionnaires and by clinical and laboratory assessments. RESULTS—Almost all patients in each race and ethnic group had one primary source of ambulatory medical care (92–97%), saw one physician at this source (83–92%), and had at least semiannual physician visits (83–90%). Almost all patients ≥65 years of age had health insurance (99–100%), and for those patients <65 years of age, Caucasians (91%) and African-Americans (89%) had higher rates of coverage than Mexican-Americans (66%). Rates of treatment with insulin or oral agents (71–78%), eye examination in the previous year (61–70%), blood pressure check in the previous 6 months (83–89%), and the proportion of hypertension that was diagnosed (84–91%) were similar for each race and ethnic group. Lower proportions of African-Americans and Mexican-Americans self-monitored their blood glucose (insulin-treated, 27 vs. 44% of Caucasians), had their cholesterol checked (62–68 vs. 81%), and had their dyslipidemia diagnosed (45 vs. 58%). African-American and Mexican-American patients had a somewhat higher proportion than Caucasian patients, with HbA1c ≥7% (58–66 vs. 55%), blood pressure ≥140/90 mmHg among those with diagnosed hypertension (60–65 vs. 55%), and clinical proteinuria (11–14 vs. 5%). In contrast, they had better levels of total cholesterol (≥240 mg/dl) (28–30 vs. 34%) and HDL cholesterol (≥45 mg/dl) (46–59 vs. 38%), and African-American and Mexican-American men were less overweight than Caucasian men (BMI ≥30) (34–37 vs. 44%), although the opposite was true for women. LDL cholesterol levels and the proportion of patients who smoked cigarettes or were hospitalized in the past year were similar among all three groups. In logistic regression analysis, there was little evidence that levels of blood glucose, blood pressure, lipids, or albuminuria were associated with access to or utilization of health care or with socioeconomic status. CONCLUSIONS—There are some differences by race and ethnicity in health care access and utilization and in health status and outcomes for adults with type 2 diabetes. However, the magnitude of these differences pale in comparison with the suboptimal health status of all three race and ethnic groups relative to established treatment goals. Health status does not appear to be influenced by access to health care.