Geographic and Racial/Ethnic Variation in Glycemic Control and Treatment in a National Sample of Veterans With Diabetes
| Autor: | Mark F Guagliardo, R. Neal Axon, Ernest Moy, John Bian, Brian Neelon, John L. Pearce, Melanie L. Davis, Kelly J. Hunt |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Research design Endocrinology Diabetes and Metabolism Ethnic group 030209 endocrinology & metabolism Glycemic Control Health Services Accessibility Medication Adherence Cohort Studies 03 medical and health sciences 0302 clinical medicine Diabetes mellitus Diabetes Mellitus Ethnicity Internal Medicine medicine Humans 030212 general & internal medicine Healthcare Disparities Epidemiology/Health Services Research Aged Retrospective Studies Veterans Aged 80 and over Advanced and Specialized Nursing Geography business.industry Racial Groups Retrospective cohort study Health Status Disparities Odds ratio Middle Aged Patient Acceptance of Health Care medicine.disease Comorbidity United States United States Department of Veterans Affairs Marital status Female business Demography Cohort study |
| Zdroj: | Diabetes Care |
| ISSN: | 1935-5548 0149-5992 |
| DOI: | 10.2337/dc20-0514 |
| Popis: | OBJECTIVEGeographic and racial/ethnic disparities related to diabetes control and treatment have not previously been examined at the national level.RESEARCH DESIGN AND METHODSA retrospective cohort study was conducted in a national cohort of 1,140,634 veterans with diabetes, defined as two or more diabetes ICD-9 codes (250.xx) across inpatient and outpatient records. Main exposures of interest included 125 Veterans Administration Medical Center (VAMC) catchment areas as well as racial/ethnic group. The main outcome measure was HbA1c level dichotomized at ≥8.0% (≥64 mmol/mol).RESULTSAfter adjustment for age, sex, racial/ethnic group, service-connected disability, marital status, and the van Walraven Elixhauser comorbidity score, the prevalence of uncontrolled diabetes varied by VAMC catchment area, with values ranging from 19.1% to 29.2%. Moreover, these differences largely persisted after further adjusting for medication use and adherence as well as utilization and access metrics. Racial/ethnic differences in diabetes control were also noted. In our final models, compared with non-Hispanic Whites, non-Hispanic Blacks (odds ratio 1.11 [95% credible interval 1.09–1.14]) and Hispanics (1.36 [1.09–1.14]) had a higher odds of uncontrolled HBA1c level.CONCLUSIONSIn a national cohort of veterans with diabetes, we found geographic as well as racial/ethnic differences in diabetes control rates that were not explained by adjustment for demographics, comorbidity burden, use or type of diabetes medication, health care utilization, access metrics, or medication adherence. Moreover, disparities in suboptimal control appeared consistent across most, but not all, VAMC catchment areas, with non-Hispanic Black and Hispanic veterans having a higher odds of suboptimal diabetes control than non-Hispanic White veterans. |
| Databáze: | OpenAIRE |
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