Racial/Ethnic Disparities in Primary Care Quality Among Type 2 Diabetes Patients, Medical Expenditure Panel Survey, 2012

Background: Type 2 diabetes in the United States is more prevalent in youth of minority racial-ethnic background but disparities in health outcomes have not be examined in this population. Methods: We examined racial-ethnic differences in the initial presentation and subsequent comorbidities in youth with type 2 diabetes (N=1217, 63% females) enrolled in the Pediatric Diabetes Consortium (PDC) Registry from February 2012 to June 2018. Demographic and clinical data were collected from medical records and participant self-report. Results: Overall, the mean age at presentation was 13.4 ± 2.4 years, BMI was 35.0 (9.4) kg/m2. HbA1c was higher and C-peptide was lower in Non-Hispanic Black (NHB) and Hispanic (H) youth compared to Non-Hispanic White (NHW) youth. NHB were 3 times as likely to present in DKA (19%) vs. NHW (6.3%) and H (7.5%) and both NHB and H had a worse HbA1c trajectory compared with NHW peers. Microalbuminuria was documented in 11%, hypertension in 34% and dyslipidemia in 42% of Registry participants with no significant difference among racial-ethnic groups. Non-alcoholic fatty liver disease (NAFLD) was diagnosed in 9% and 11% of H and NHW, respectively vs. 2% in NHB. Conclusion: NHB and H youth with type 2 diabetes presented with worse metabolic control and had persistently worse HbA1c trajectories compared with NHW. Comorbidities exist in a large percentage of these youth independent of race-ethnicity, except for NAFLD being less prevalent in NHB. Greater efforts are needed to mitigate racial-ethnic disparities at diagnosis and in the management of youth with type 2 diabetes.

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Racial and Ethnic Disparities in Comorbidities in Youth With Type 2 Diabetes in the Pediatric Diabetes Consortium (PDC)

10.2337/figshare.15174003 ◽

2021 ◽

Author(s):

Fida Bacha ◽

Peiyao Cheng ◽

Robin L. Gal ◽

Lindsey C. Beaulieu ◽

Craig Kollman ◽

...

Keyword(s):

Type 2 Diabetes ◽

Ethnic Disparities ◽

The United States ◽

Self Report ◽

Alcoholic Fatty Liver ◽

Pediatric Diabetes ◽

Significant Difference ◽

Racial Ethnic ◽

Hispanic White

Background: Type 2 diabetes in the United States is more prevalent in youth of minority racial-ethnic background but disparities in health outcomes have not be examined in this population. Methods: We examined racial-ethnic differences in the initial presentation and subsequent comorbidities in youth with type 2 diabetes (N=1217, 63% females) enrolled in the Pediatric Diabetes Consortium (PDC) Registry from February 2012 to June 2018. Demographic and clinical data were collected from medical records and participant self-report. Results: Overall, the mean age at presentation was 13.4 ± 2.4 years, BMI was 35.0 (9.4) kg/m2. HbA1c was higher and C-peptide was lower in Non-Hispanic Black (NHB) and Hispanic (H) youth compared to Non-Hispanic White (NHW) youth. NHB were 3 times as likely to present in DKA (19%) vs. NHW (6.3%) and H (7.5%) and both NHB and H had a worse HbA1c trajectory compared with NHW peers. Microalbuminuria was documented in 11%, hypertension in 34% and dyslipidemia in 42% of Registry participants with no significant difference among racial-ethnic groups. Non-alcoholic fatty liver disease (NAFLD) was diagnosed in 9% and 11% of H and NHW, respectively vs. 2% in NHB. Conclusion: NHB and H youth with type 2 diabetes presented with worse metabolic control and had persistently worse HbA1c trajectories compared with NHW. Comorbidities exist in a large percentage of these youth independent of race-ethnicity, except for NAFLD being less prevalent in NHB. Greater efforts are needed to mitigate racial-ethnic disparities at diagnosis and in the management of youth with type 2 diabetes.

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RACIAL DISPARITIES IN ACCESS TO AND COST OF HEALTHCARE AMONG OLDER ADULTS WITH COGNITIVE LIMITATION: 2002 TO 2016

Innovation in Aging ◽

10.1093/geroni/igz038.2085 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S564-S564

Author(s):

Elham Mahmoudi

Keyword(s):

Older Adults ◽

Prescription Drugs ◽

Linear Models ◽

Medical Expenditure Panel Survey ◽

Ethnic Disparities ◽

Office Visit ◽

Medical Expenditure ◽

Office Visits ◽

Vulnerable Subpopulations ◽

Racial Ethnic

Abstract Using 2002-2016 Medical Expenditure Panel Survey, we examined racial/ethnic disparities in office-visits and prescription-drugs among individuals with cognitive limitation (CL). Medicare beneficiaries (65+) with CL (N=9,369) were included. We used generalized linear models. Prevalence of CL increased overtime among all racial/ethnic groups. Our findings indicate that 96% of Whites vs. 93% of Blacks had at least one office visit (diff=0.03; 95% CI:0.01-0.04). Whites had 2 (95% CI: 1.0-0.4) and 4 (95% CI: 2.5-6.0) more office visits compared with Hispanics and Asians; and used 4 (95% CI: 1-6.9), 5 (95% CI:1.0-9.3) and 6 (95% CI: 1.0-11.5) more prescriptions than their Blacks, Hispanics, and Asians, respectively. Whites had higher annual expenditures for office-visits compared with Asians ($889; 95% CI:409-1,368) and higher expenditures for prescriptions compared with Blacks ($484; 95% CI:$151-$816) and Asians ($546; 95% CI:$28-$1064), respectively. Disparities in care among older adults with CL may put vulnerable subpopulations at a higher risk.

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