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Comparative Study
. 2009 Jun;47(6):700-6.
doi: 10.1097/mlr.0b013e318192609d.

Identifying risk factors for racial disparities in diabetes outcomes: the translating research into action for diabetes study

O Kenrik Duru  1 , Robert B Gerzoff, Joseph V Selby, Arleen F Brown, Ronald T Ackermann, Andrew J Karter, Sonja Ross, Neil Steers, William H Herman, Beth Waitzfelder, Carol M Mangione
Affiliations
Comparative Study

Identifying risk factors for racial disparities in diabetes outcomes: the translating research into action for diabetes study

O Kenrik Duru et al. Med Care. 2009 Jun.

Abstract

Background: Versus whites, blacks with diabetes have poorer control of hemoglobin A1c (HbA1c), higher systolic blood pressure (SBP), and higher low-density lipoprotein (LDL) cholesterol as well as higher rates of morbidity and microvascular complications.

Objective: To examine whether several mutable risk factors were more strongly associated with poor control of multiple intermediate outcomes among blacks with diabetes than among similar whites.

Design: Case-control study.

Subjects: A total of 764 blacks and whites with diabetes receiving care within 8 managed care health plans.

Measures: Cases were patients with poor control of at least 2 of 3 intermediate outcomes (HbA1c > or =8.0%, SBP > or =140 mmHg, LDL cholesterol > or =130 mg/dL) and controls were patients with good control of all 3 (HbA1c <8.0%, SBP <140 mmHg, LDL cholesterol <130 mg/dL). In multivariate analyses, we determined whether each of several potentially mutable risk factors, including depression, poor adherence to medications, low self-efficacy for reducing cardiovascular risk, and poor patient-provider communication, predicted case or control status.

Results: Among blacks but not whites, in multivariate analyses depression (odds ratio: 2.28; 95% confidence interval: 1.09-4.75) and having missed medication doses (odds ratio: 1.96; 95% confidence interval: 1.01-3.81) were associated with greater odds of being a case rather than a control. None of the other risk factors were associated for either blacks or whites.

Conclusions: Depression and missing medication doses are more strongly associated with poor diabetes control among blacks than in whites. These 2 risk factors may represent important targets for patient-level interventions to address racial disparities in diabetes outcomes.

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Figures

Figure
Figure
Key potential determinants of health disparities within the health care system, including individual, provider, and health care system factors Kilbourne AM, et al.
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