Not all healthcare inequities in diabetes are equal: a comparison of two medically underserved cohorts

IntroductionDiabetes disparities exist based on socioeconomic status, race, and ethnicity. The aim of this study is to compare two cohorts with diabetes from California and Florida to better elucidate how health outcomes are stratified within underserved communities according to state location, race...

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Bibliographic Details
Published in:BMJ open diabetes research & care 2024-09, Vol.12 (4), p.e004229
Main Authors: Walker, Ashby F, Haller, Michael J, Addala, Ananta, Filipp, Stephanie L, Lal, Rayhan, Gurka, Matthew J, Figg, Lauren E, Hechavarria, Melanie, Zaharieva, Dessi P, Malden, Keilecia G, Hood, Korey K, Westen, Sarah C, Wong, Jessie J, Donahoo, William T, Basina, Marina, Bernier, Angelina V, Duncan, Paul, Maahs, David M
Format: Article
Language:English
Subjects:
Adult
California - epidemiology
Cohort Studies
Diabetes
Diabetes Mellitus - epidemiology
Diabetes Mellitus, Type 1
Diabetes Mellitus, Type 1 - epidemiology
Diabetes Mellitus, Type 2
Diabetes Mellitus, Type 2 - epidemiology
Electronic health records
Epidemiology/Health services research
Female
Florida - epidemiology
Follow-Up Studies
Glycated Hemoglobin - analysis
Health care policy
Health Policy
Healthcare Disparities
Healthcare Disparities - statistics & numerical data
Humans
Indigent care
Male
Medically Underserved Area
Middle Aged
Original Research
Socioeconomic Factors
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Summary:IntroductionDiabetes disparities exist based on socioeconomic status, race, and ethnicity. The aim of this study is to compare two cohorts with diabetes from California and Florida to better elucidate how health outcomes are stratified within underserved communities according to state location, race, and ethnicity.Research design and methodsTwo cohorts were recruited for comparison from 20 Federally Qualified Health Centers as part of a larger ECHO Diabetes program. Participant-level data included surveys and HbA1c collection. Center-level data included Healthcare Effectiveness Data and Information Set metrics. Demographic characteristics were summarized overall and stratified by state (frequencies, percentages, means (95% CIs)). Generalized linear mixed models were used to compute and compare model-estimated rates and means.ResultsParticipant-level cohort: 582 adults with diabetes were recruited (33.0% type 1 diabetes (T1D), 67.0% type 2 diabetes (T2D)). Mean age was 51.1 years (95% CI 49.5, 52.6); 80.7% publicly insured or uninsured; 43.7% non-Hispanic white (NHW), 31.6% Hispanic, 7.9% non-Hispanic black (NHB) and 16.8% other. Center-level cohort: 32 796 adults with diabetes were represented (3.4% with T1D, 96.6% with T2D; 72.7% publicly insured or uninsured). Florida had higher rates of uninsured (p
ISSN:2052-4897
2052-4897
DOI:10.1136/bmjdrc-2024-004229