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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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| Published in: | BMJ open diabetes research & care 2024-09, Vol.12 (4), p.e004229 |
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| container_title | BMJ open diabetes research & care |
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| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1136/bmjdrc-2024-004229 |
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| fullrecord | <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_664069a3bede4368930175b75ad46a11</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_664069a3bede4368930175b75ad46a11</doaj_id><sourcerecordid>3101793513</sourcerecordid><originalsourceid>FETCH-LOGICAL-b417t-f5684248fe1f9d6fb7a3fe4df651b5e4113034f2e4792101a6db67b1237c843e3</originalsourceid><addsrcrecordid>eNp9kktv1TAQhS0EotWlf4AFssSGTYpfsRM2CFU8KlWwgbVlx-NeXyXxre206r_HtymlZcHKI893zvhYg9BrSk4p5fK9nXYuDQ0jTDSECMb6Z-iYkZY1ouvV80f1ETrJeUcIqTLKu_YlOuI9E4wydoz891iwGUe8BTOW7WAS4DDD1RJKgFxL7IKxUGp9aNWGGT9gg4c47U0KOc44elxuIp7AhaE63eJldpAypGtwldvGVPIr9MKbMcPJ_blBv758_nn2rbn48fX87NNFYwVVpfGt7AQTnQfqeye9VYZ7EM7LltoWRE1OuPAMhOoZJdRIZ6WylHE1dIID36Dz1ddFs9P7FCaTbnU0Qd9dxHSpTSphGEFLKYjsDbfgQHDZ9ZxQ1VrVGiekqZM26OPqtV9sDTfAXJIZn5g-7cxhqy_jta7ajirWVod39w4pXi2Qi55CHmAczQxxyZrXCKrnLeUVffsPuotLmutf3VG8F1KJSrGVGlLMOYF_eA0lh7FSr2uhD2uh17WoojePczxI_ixBBU5XoIr_jv2P429Xp8LJ</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3101394674</pqid></control><display><type>article</type><title>Not all healthcare inequities in diabetes are equal: a comparison of two medically underserved cohorts</title><source>BMJ Open Access Journals</source><source>PubMed Central Free</source><source>Publicly Available Content Database</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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<0.0001), lower continuous glucose monitor (CGM) use (18.3% Florida; 35.9% California, p<0.0001), and pump use (10.2% Florida; 26.5% California, p<0.0001), and higher proportions of people with T1D/T2D>9% HbA1c (p<0.001). Risk was stratified within states with NHB participants having higher HbA1c (mean 9.5 (95% CI 8.9, 10.0) compared with NHW with a mean of 8.4 (95% CI 7.8, 9.0), p=0.0058), lower pump use (p=0.0426) and CGM use (p=0.0192). People who prefer to speak English were more likely to use a CGM (p=0.0386).ConclusionsCharacteristics of medically underserved communities with diabetes vary by state and by race and ethnicity. Florida’s lack of Medicaid expansion could be a factor in worsened risks for vulnerable communities with diabetes.</description><identifier>ISSN: 2052-4897</identifier><identifier>EISSN: 2052-4897</identifier><identifier>DOI: 10.1136/bmjdrc-2024-004229</identifier><identifier>PMID: 39242122</identifier><language>eng</language><publisher>England: American Diabetes Association</publisher><subject>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</subject><ispartof>BMJ open diabetes research & care, 2024-09, Vol.12 (4), p.e004229</ispartof><rights>Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2024 Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-b417t-f5684248fe1f9d6fb7a3fe4df651b5e4113034f2e4792101a6db67b1237c843e3</cites><orcidid>0000-0002-2803-1824 ; 0000-0003-2222-3451 ; 0000-0002-0508-4309 ; 0000-0002-7554-2344 ; 0000-0002-9374-8469</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/3101394674/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/3101394674?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,55350,75126,77660,77686</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39242122$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Walker, Ashby F</creatorcontrib><creatorcontrib>Haller, Michael J</creatorcontrib><creatorcontrib>Addala, Ananta</creatorcontrib><creatorcontrib>Filipp, Stephanie L</creatorcontrib><creatorcontrib>Lal, Rayhan</creatorcontrib><creatorcontrib>Gurka, Matthew J</creatorcontrib><creatorcontrib>Figg, Lauren E</creatorcontrib><creatorcontrib>Hechavarria, Melanie</creatorcontrib><creatorcontrib>Zaharieva, Dessi P</creatorcontrib><creatorcontrib>Malden, Keilecia G</creatorcontrib><creatorcontrib>Hood, Korey K</creatorcontrib><creatorcontrib>Westen, Sarah C</creatorcontrib><creatorcontrib>Wong, Jessie J</creatorcontrib><creatorcontrib>Donahoo, William T</creatorcontrib><creatorcontrib>Basina, Marina</creatorcontrib><creatorcontrib>Bernier, Angelina V</creatorcontrib><creatorcontrib>Duncan, Paul</creatorcontrib><creatorcontrib>Maahs, David M</creatorcontrib><title>Not all healthcare inequities in diabetes are equal: a comparison of two medically underserved cohorts</title><title>BMJ open diabetes research & care</title><addtitle>BMJ Open Diab Res Care</addtitle><addtitle>BMJ Open Diabetes Res Care</addtitle><description>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<0.0001), lower continuous glucose monitor (CGM) use (18.3% Florida; 35.9% California, p<0.0001), and pump use (10.2% Florida; 26.5% California, p<0.0001), and higher proportions of people with T1D/T2D>9% HbA1c (p<0.001). Risk was stratified within states with NHB participants having higher HbA1c (mean 9.5 (95% CI 8.9, 10.0) compared with NHW with a mean of 8.4 (95% CI 7.8, 9.0), p=0.0058), lower pump use (p=0.0426) and CGM use (p=0.0192). People who prefer to speak English were more likely to use a CGM (p=0.0386).ConclusionsCharacteristics of medically underserved communities with diabetes vary by state and by race and ethnicity. Florida’s lack of Medicaid expansion could be a factor in worsened risks for vulnerable communities with diabetes.</description><subject>Adult</subject><subject>California - epidemiology</subject><subject>Cohort Studies</subject><subject>Diabetes</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Diabetes Mellitus, Type 1</subject><subject>Diabetes Mellitus, Type 1 - epidemiology</subject><subject>Diabetes Mellitus, Type 2</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Electronic health records</subject><subject>Epidemiology/Health services research</subject><subject>Female</subject><subject>Florida - epidemiology</subject><subject>Follow-Up Studies</subject><subject>Glycated Hemoglobin - analysis</subject><subject>Health care policy</subject><subject>Health Policy</subject><subject>Healthcare Disparities</subject><subject>Healthcare Disparities - statistics & numerical data</subject><subject>Humans</subject><subject>Indigent care</subject><subject>Male</subject><subject>Medically Underserved Area</subject><subject>Middle Aged</subject><subject>Original Research</subject><subject>Socioeconomic Factors</subject><issn>2052-4897</issn><issn>2052-4897</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp9kktv1TAQhS0EotWlf4AFssSGTYpfsRM2CFU8KlWwgbVlx-NeXyXxre206r_HtymlZcHKI893zvhYg9BrSk4p5fK9nXYuDQ0jTDSECMb6Z-iYkZY1ouvV80f1ETrJeUcIqTLKu_YlOuI9E4wydoz891iwGUe8BTOW7WAS4DDD1RJKgFxL7IKxUGp9aNWGGT9gg4c47U0KOc44elxuIp7AhaE63eJldpAypGtwldvGVPIr9MKbMcPJ_blBv758_nn2rbn48fX87NNFYwVVpfGt7AQTnQfqeye9VYZ7EM7LltoWRE1OuPAMhOoZJdRIZ6WylHE1dIID36Dz1ddFs9P7FCaTbnU0Qd9dxHSpTSphGEFLKYjsDbfgQHDZ9ZxQ1VrVGiekqZM26OPqtV9sDTfAXJIZn5g-7cxhqy_jta7ajirWVod39w4pXi2Qi55CHmAczQxxyZrXCKrnLeUVffsPuotLmutf3VG8F1KJSrGVGlLMOYF_eA0lh7FSr2uhD2uh17WoojePczxI_ixBBU5XoIr_jv2P429Xp8LJ</recordid><startdate>20240905</startdate><enddate>20240905</enddate><creator>Walker, Ashby F</creator><creator>Haller, Michael J</creator><creator>Addala, Ananta</creator><creator>Filipp, Stephanie L</creator><creator>Lal, Rayhan</creator><creator>Gurka, Matthew J</creator><creator>Figg, Lauren E</creator><creator>Hechavarria, Melanie</creator><creator>Zaharieva, Dessi P</creator><creator>Malden, Keilecia G</creator><creator>Hood, Korey K</creator><creator>Westen, Sarah C</creator><creator>Wong, Jessie J</creator><creator>Donahoo, William T</creator><creator>Basina, Marina</creator><creator>Bernier, Angelina V</creator><creator>Duncan, Paul</creator><creator>Maahs, David M</creator><general>American Diabetes Association</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-2803-1824</orcidid><orcidid>https://orcid.org/0000-0003-2222-3451</orcidid><orcidid>https://orcid.org/0000-0002-0508-4309</orcidid><orcidid>https://orcid.org/0000-0002-7554-2344</orcidid><orcidid>https://orcid.org/0000-0002-9374-8469</orcidid></search><sort><creationdate>20240905</creationdate><title>Not all healthcare inequities in diabetes are equal: a comparison of two medically underserved cohorts</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b417t-f5684248fe1f9d6fb7a3fe4df651b5e4113034f2e4792101a6db67b1237c843e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>California - epidemiology</topic><topic>Cohort Studies</topic><topic>Diabetes</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Diabetes Mellitus, Type 1</topic><topic>Diabetes Mellitus, Type 1 - epidemiology</topic><topic>Diabetes Mellitus, Type 2</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Electronic health records</topic><topic>Epidemiology/Health services research</topic><topic>Female</topic><topic>Florida - epidemiology</topic><topic>Follow-Up Studies</topic><topic>Glycated Hemoglobin - analysis</topic><topic>Health care policy</topic><topic>Health Policy</topic><topic>Healthcare Disparities</topic><topic>Healthcare Disparities - statistics & numerical data</topic><topic>Humans</topic><topic>Indigent care</topic><topic>Male</topic><topic>Medically Underserved Area</topic><topic>Middle Aged</topic><topic>Original Research</topic><topic>Socioeconomic Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Walker, Ashby F</creatorcontrib><creatorcontrib>Haller, Michael J</creatorcontrib><creatorcontrib>Addala, Ananta</creatorcontrib><creatorcontrib>Filipp, Stephanie L</creatorcontrib><creatorcontrib>Lal, Rayhan</creatorcontrib><creatorcontrib>Gurka, Matthew J</creatorcontrib><creatorcontrib>Figg, Lauren E</creatorcontrib><creatorcontrib>Hechavarria, Melanie</creatorcontrib><creatorcontrib>Zaharieva, Dessi P</creatorcontrib><creatorcontrib>Malden, Keilecia G</creatorcontrib><creatorcontrib>Hood, Korey K</creatorcontrib><creatorcontrib>Westen, Sarah C</creatorcontrib><creatorcontrib>Wong, Jessie J</creatorcontrib><creatorcontrib>Donahoo, William T</creatorcontrib><creatorcontrib>Basina, Marina</creatorcontrib><creatorcontrib>Bernier, Angelina V</creatorcontrib><creatorcontrib>Duncan, Paul</creatorcontrib><creatorcontrib>Maahs, David M</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>BMJ open diabetes research & care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Walker, Ashby F</au><au>Haller, Michael J</au><au>Addala, Ananta</au><au>Filipp, Stephanie L</au><au>Lal, Rayhan</au><au>Gurka, Matthew J</au><au>Figg, Lauren E</au><au>Hechavarria, Melanie</au><au>Zaharieva, Dessi P</au><au>Malden, Keilecia G</au><au>Hood, Korey K</au><au>Westen, Sarah C</au><au>Wong, Jessie J</au><au>Donahoo, William T</au><au>Basina, Marina</au><au>Bernier, Angelina V</au><au>Duncan, Paul</au><au>Maahs, David M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Not all healthcare inequities in diabetes are equal: a comparison of two medically underserved cohorts</atitle><jtitle>BMJ open diabetes research & care</jtitle><stitle>BMJ Open Diab Res Care</stitle><addtitle>BMJ Open Diabetes Res Care</addtitle><date>2024-09-05</date><risdate>2024</risdate><volume>12</volume><issue>4</issue><spage>e004229</spage><pages>e004229-</pages><issn>2052-4897</issn><eissn>2052-4897</eissn><abstract>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<0.0001), lower continuous glucose monitor (CGM) use (18.3% Florida; 35.9% California, p<0.0001), and pump use (10.2% Florida; 26.5% California, p<0.0001), and higher proportions of people with T1D/T2D>9% HbA1c (p<0.001). Risk was stratified within states with NHB participants having higher HbA1c (mean 9.5 (95% CI 8.9, 10.0) compared with NHW with a mean of 8.4 (95% CI 7.8, 9.0), p=0.0058), lower pump use (p=0.0426) and CGM use (p=0.0192). People who prefer to speak English were more likely to use a CGM (p=0.0386).ConclusionsCharacteristics of medically underserved communities with diabetes vary by state and by race and ethnicity. Florida’s lack of Medicaid expansion could be a factor in worsened risks for vulnerable communities with diabetes.</abstract><cop>England</cop><pub>American Diabetes Association</pub><pmid>39242122</pmid><doi>10.1136/bmjdrc-2024-004229</doi><orcidid>https://orcid.org/0000-0002-2803-1824</orcidid><orcidid>https://orcid.org/0000-0003-2222-3451</orcidid><orcidid>https://orcid.org/0000-0002-0508-4309</orcidid><orcidid>https://orcid.org/0000-0002-7554-2344</orcidid><orcidid>https://orcid.org/0000-0002-9374-8469</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | BMJ open diabetes research & care, 2024-09, Vol.12 (4), p.e004229 |
| issn | 2052-4897 2052-4897 |
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| source | BMJ Open Access Journals; PubMed Central Free; Publicly Available Content Database |
| 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 |
| title | Not all healthcare inequities in diabetes are equal: a comparison of two medically underserved cohorts |
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