ArticleGender differences across racial and ethnic groups in the quality of care for diabetes
Introduction
Diabetes is the sixth leading cause of death in the United States, with mortality rates for adults with diabetes being twice that of the general population (American Diabetes Association 2003a, American Diabetes Association 2003b). In 2005, 20.8 million people had diabetes with 14.6 million people diagnosed and 6.2 million undiagnosed (Centers for Disease Control and Prevention [CDC], 2005). Diabetes affects 9.7 million women and 10.9 million men age 20 and over. Prevalence for the various racial/ethnic groups is: non-Hispanic whites (13.1 million), non-Hispanic blacks (3.2 million), Hispanic/Latino Americans (2.5 million), and American Indians/Alaska Natives (117,994). Prevalence is also high among people with lower educational levels. Diabetes prevalence in the general population is projected to increase by 44% by 2020: 107% for Hispanics and 56% for older adults (American Diabetes Association 2002, American Diabetes Association 2003b). Diabetes-related mortality rates are higher among blacks, Native Americans, and Hispanics (Mokdad et al., 2000). Diabetes is associated with a range of other illnesses and is a major risk factor for cardiovascular disease. People with diabetes are at increased risk for stroke, ischemic heart disease, peripheral vascular disease, and neuropathy (American Diabetes Association 2002, American Diabetes Association 2003b). Blacks have higher rates of serious complications from diabetes, including higher rates of end-stage renal disease and lower extremity amputation (Centers for Disease Control and Prevention 1999, Guadagnoli et al 1995, Gornick et al 1996).
Diabetes is a public health and economic concern. The total cost of the disease in the United States for 2002 was estimated at $132 billion, of which $91.8 billion was attributed to direct medical costs and $40 billion to indirect costs owing to disability, work loss, and premature mortality (American Diabetes Association, 2003a).
Diabetes is a preventable disease that can be effectively managed to delay or avoid its complications (Centers for Disease Control and Prevention (CDC) 2004, Heisler et al 2003, Hill-Briggs et al 2003). To identify gaps in care and avoid unnecessary expense, monitoring the ongoing quality of health care in patients with diabetes is crucial. Despite evidence currently available on the best practices in diabetes care, there is still wide variation in diagnostic evaluation, use of preventive services, and the quality and extent of disease management (American Diabetes Association 2003b, Diabetes Prevention Program Research Group 2002, Dallo and Weller 2003).
The purpose of this study is to investigate whether gender differences across racial/ethnic groups exist in the quality of care received by people who suffer from type 2 diabetes. The quality of care for diabetes is evaluated according to 10 process and outcomes measures as defined by the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR) (Agency for Healthcare Research and Quality 2005a, Agency for Healthcare Research and Quality 2005b, Agency for Healthcare Research and Quality 2004a, Agency for Healthcare Research and Quality 2004b). The paper’s unique contribution is that it goes beyond the scope of the national reports by performing additional data analysis by gender within racial/ethnic groups. Our findings provide the basis for future development of gender- and/or race/ethnicity-specific strategies to help close the gaps in diabetes care.
Section snippets
Medical Expenditure Panel Survey
The Medical Expenditure Panel Survey (MEPS) collects data through computer-assisted, in-person interviews of a nationally representative sample of the noninstitutionalized civilian population using a stratified multistage probability design. This analysis uses data from the MEPS Household Component as well as the Diabetes Care Survey supplement of the MEPS, which is a paper-and-pencil questionnaire administered to household respondents who answered “yes” when asked whether they were ever told
Results
Results are presented by gender for the following racial/ethnic groups: non-Hispanic whites, non-Hispanic blacks, and Hispanics. Gender analysis across other racial/ethnic groups (e.g., Asians, Pacific Islanders, and Native Americans/Alaska Natives) was not possible because data were found to be of nonreliable statistical significance (sample size inadequate). These populations were, therefore, excluded from the study.
Discussion
Diabetes is a complex chronic disease requiring comprehensive quality care. Studies have shown that when appropriate care is provided, lower diabetes-related stress and fewer emergency room and doctor’s office visits are reported (Centers for Disease Control and Prevention (CDC) 2004, Heisler et al 2003, Hill-Briggs et al 2003). Although research on the management of diabetes has not concentrated on men or women specifically (Shojania, McDonald, Wachter & Owens, 2004), the disparities in
Acknowledgments
The authors would like to acknowledge the statewide data organizations that participate in the 2001 HCUP Nationwide Inpatient Sample (NIS): Arizona Department of Health Services; California Office of Statewide Health Planning & Development; Colorado Health & Hospital Association; Connecticut–Chime, Inc.; Florida Agency for Health Care Administration; Georgia Hospital Association; Hawaii Health Information Corporation; Illinois Health Care Cost Containment Council; Iowa Hospital Association;
Rosaly Correa-de-Araujo, MD, MSc, PhD, is a cardiovascular pathologist trained at the National Heart, Lung, and Blood Institute. As the Agency for Healthcare Research and Quality’s Director of Women’s Health and Gender-Based Research, Dr. Correa oversees the development of a national research agenda for women in consultation with prominent members of the research community and other government agencies. Her main areas of interest include gender-based research and analysis particularly related
References (32)
National Healthcare Disparities Report
(2005)National Healthcare Quality Report
(2005)2004 National Healthcare Disparities Report
(2004)2004 National Healthcare Quality Report
(2004)2004 National Healthcare Quality Report, Measure Specifications Appendix
(2004)Diabetes fact sheet
(2002)Economic costs of diabetes in the US in 2002
Diabetes Care
(2003)Standards of medical care for patients with diabetes mellitus
Diabetes Care
(2003)- et al.
Measurement challenges in developing the National Healthcare Quality Report and the National Healthcare Disparities Report
Medical Care
(2005) Diabetes Surveillance, 1999
(1999)
National diabetes fact sheet, 2005
At a glance, diabetesDisabling, deadly, and on the rise
Diabetes in the African-American population. Morbidityquality of careand resource utilization
Diabetes Care
Methods Applying AHRQ Quality Indicators to Healthcare Cost and Utilization Project (HCUP) Data for the National Healthcare Disparities Report. Draft
Diabetes care quality improvementA resource guide for State action
Ambulatory medical care for non-Hispanic whites, African Americans, and Mexican-Americans with NIDDM in the U.S.
Diabetes Care
Cited by (0)
Rosaly Correa-de-Araujo, MD, MSc, PhD, is a cardiovascular pathologist trained at the National Heart, Lung, and Blood Institute. As the Agency for Healthcare Research and Quality’s Director of Women’s Health and Gender-Based Research, Dr. Correa oversees the development of a national research agenda for women in consultation with prominent members of the research community and other government agencies. Her main areas of interest include gender-based research and analysis particularly related to chronic diseases, medication use outcomes and safety, and disparities in health care.
Kelly McDermott, MA, is currently a predoctoral student in health services research at the University of Washington in Seattle.
Ernest Moy, MD, MPH, is a Senior Service Fellow with the Center for Quality Improvement and Patient Safety in the Agency for Healthcare Research and Quality. Dr. Moy leads the development of the National Healthcare Disparities Report.
The views expressed in this article are those of the authors and do not necessarily represent the views of the Agency for Healthcare Research and Quality or the Federal government