Introduction
Early screening for diabetes is the most cost effective way to prevent complications. Diabetes screening rates in a clinical population are unknown. There are well-known racial/ethnic differences in diabetes prevalence, with some Asian Americans racial/ethnic subgroups (e.g. Asian Indian and Filipino) having higher rates than Non Hispanic White (NHW) populations, and this may result in higher rates of diabetes screening for Asian Americans.
Hypothesis
We hypothesized that, after taking into account other risks factors suggested by national guidelines, Asian Americans may have higher preventive screening rates, given known higher risk for diabetes.
Methods
We used the electronic health records data from a large multi-specialty, mixed-payer, outpatient, group- practice organization in Northern California, to examine an observational prospective dataset during 1/1/2007-09/30/2010. Active primary care patients who were 35 years or older, not pregnant, identified as Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) or non-Hispanic white (NHW), and were free from diabetes at baseline were included (N=110,477). Screening was defined as fasting glucose, oral glucose tolerance test, or HgBA1C. Racial/ethnic differences in screening rates were initially examined with age-sex standardization. We then estimated a Cox proportional hazard model, which adjusted for diabetes clinical risk factors (including age, sex, BMI, high blood pressure, high LDL, low HDL), family history of diabetes, insurance coverage, and frequency of primary care visits.
Results
Standardized preventive screening rates were higher for all Asian racial/ethnic subgroups (ranging from 82.2%: Japanese to 88.7%: Filipino) than NHW (78.6%)(
P<0.05
). The results were consistent in the fully adjusted Cox model where all the Asian racial/ethnic subgroups, except for Japanese (not significant), were more likely to be screened than NHWs (HR=Asian Indian: 1.29, Chinese: 1.20, Filipino: 1.22, Korean: 1.13, Vietnamese: 1.24; all
P<0.01
). Most clinical risk factors were significant positive predictors of screening, including age, female, high blood pressure, high LDL, low HDL, and family history of diabetes(all
P<0.01
).
Conclusions
Screening rates for diabetes in an insured, ambulatory care population is generally high (∼80%). Clinical risk factors and Asian race/ethnicity are predictors of appropriate diabetes screening.
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