Do diabetic patients living in racially segregated neighborhoods experience different access and quality of care?

Abstract

Background: Place of residence, particularly residential segregation, has been implicated in health and health care disparities. However, prior studies have not focused on care for diabetes, a prevalent condition for minority populations.

Objective: To examine the association of residential segregation with a range of access and quality of care outcomes among black and Hispanics with diabetes using a nationally representative US sample.

Research design: Cross-sectional study using data for 1598 adult patients with diabetes from the 2006 Medical Expenditure Panel Survey linked to residential segregation information for blacks and Hispanics on the basis of the 2000 census. Relationships of 5 dimensions of residential segregation (dissimilarity, isolation, clustering, concentration, and centralization) with access and quality of care outcomes were examined using linear, logistic, and multinomial logistic regression models, controlling for respondent characteristics and community utilization and hospital capacity.

Results: Black and Hispanics with diabetes had comparable or better access to providers, but received fewer recommended services. Living in a segregated community was associated with more recommended services received, but also problems with seeing a specialist. The relationship of residential segregation to diabetes care varied depending on type of segregation and race/ethnic group assessed.

Conclusions: Residential segregation influences the care experience of patients with diabetes in the United States. Our study highlights the importance of investigating how different types of segregation may affect diabetes care received by patients from different race and ethnic groups.

Figure 1

Receipt of All 4 Recommended Diabetes Service for Black, Hispanic, and White Respondents in High Segregation Compared to Low Segregation MSAs by Segregation Type. High (Black) indicates high segregation between Blacks and Whites for that dimension; High (Hispanic) indicates high segregation between Hispanic and Whites for that dimension; Low indicates low segregation for both Blacks and Hispanics for that dimension. * < p0.05, ** p<0.01.

Figure 1

Receipt of All 4 Recommended Diabetes Service for Black, Hispanic, and White Respondents in High Segregation Compared to Low Segregation MSAs by Segregation Type. High (Black) indicates high segregation between Blacks and Whites for that dimension; High (Hispanic) indicates high segregation between Hispanic and Whites for that dimension; Low indicates low segregation for both Blacks and Hispanics for that dimension. * < p0.05, ** p<0.01.

Figure 1

Receipt of All 4 Recommended Diabetes Service for Black, Hispanic, and White Respondents in High Segregation Compared to Low Segregation MSAs by Segregation Type. High (Black) indicates high segregation between Blacks and Whites for that dimension; High (Hispanic) indicates high segregation between Hispanic and Whites for that dimension; Low indicates low segregation for both Blacks and Hispanics for that dimension. * < p0.05, ** p<0.01.

Figure 1

Receipt of All 4 Recommended Diabetes Service for Black, Hispanic, and White Respondents in High Segregation Compared to Low Segregation MSAs by Segregation Type. High (Black) indicates high segregation between Blacks and Whites for that dimension; High (Hispanic) indicates high segregation between Hispanic and Whites for that dimension; Low indicates low segregation for both Blacks and Hispanics for that dimension. * < p0.05, ** p<0.01.