Sandra Albrecht, PhD, MPH
Credit: Columbia University
Improving health insurance coverage is not enough to address existing racial and ethnic disparities in glycemic control among US adults with diabetes, according to findings from a new study.
A cross-sectional analysis of more than 4000 US adults with elevated HbA1c, results of the study suggest Hispanic or Latino and non-Hispanic Black individuals were more likely to have poor glycemic control relative to their non-Hispanic White counterparts despite access to care, with investigators noting social, health care, and behavioral or health factors did little to attenuate these apparent disparities.1
- Health insurance alone doesn't reduce racial disparities in glycemic control.
- Hispanic and non-Hispanic Black individuals have poorer glycemic control despite access to care.
- Factors like social, healthcare, and health status have limited impact on these disparities.
“These findings suggest that although improving access to health care remains a critical policy target, health insurance coverage alone was not enough to reduce disparities in diabetes management,” wrote investigators.1 “Hispanic and Latino and non-Hispanic Black individuals experience a disproportionate burden of diabetes-related morbidity and mortality and associated costs”
With recent data suggesting the prevalence of type 1 diabetes and type 2 diabetes have risen in recent decades, the medical community finds itself in the midst of a historic, and still growing, public health crisis.2 With this in mind, a greater understanding of the impact and drivers of racial/ethnic disparities in management of diabetes stand to have a significant role in mitigating the impact of growing prevalence on the US public health system.
In the current study, a team led by Sandra Albrecht, PhD, MPH, of Columbia University Irving Medical Center, sought to examine trends in disparities in glycemic control associated with race and ethnicity among adults with private and public insurance, with an additional interest in estimating the effect of social, health care, and behavioral or health factors on any potential disparities. With this in mind, investigators designed their research endeavor as a cross-sectional analysis of data obtained from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018 and used poor glycemic control, which investigators defined as an HbA1c of 7.0% or greater, as the primary outcome of interest for the study.1
Through a search of NHANES, investigators identified 4070 individuals aged 25 to 80 years with self-reported diabetes and health insurance. The overall cohort had a weight mean age of 61.4 (Standard Error [SE], 0.27) years and 49.3% were women. Among the 4070 included, 1146 were Hispanic or Latino individuals, 1196 were non-Hispanic Black individuals, and 1728 were non-Hispanic White individuals. Investigators pointed out this cohort was representative of 16,337,362 US adults.1
When adjusting for age, sex, and survey year, results suggest Hispanic or Latino (Odds ratio [OR], 1.46; 95% Confidence Interval [CI], 1.16-1.83) and non-Hispanic Black (OR, 1.28; 95% CI, 1.04-1.57) individuals had significantly greater odds of poor glycemic control than non-Hispanic White individuals. Investigators highlighted further analysis indicated there was some attenuation after adjustment for social factors, but accounting for health care and behavioral or health status increased disparities, particularly among Hispanic or Latino individuals (OR, 1.63; 95% CI, 1.24-2.16). Investigators noted further subgroup analysis according to public or private insurance suggested these disparities continued to persist among those with private insurance (OR, 1.66; 95% CI, 1.10-2.52).1
“Future studies should apply causal frameworks to evaluate the role of other structural barriers contributing to the high burden of poor control among insured Hispanic or Latino and non-Hispanic Black individuals to develop effective interventions,” investigators concluded.1
- Zakaria NI, Tehranifar P, Laferrère B, Albrecht SS. Racial and Ethnic Disparities in Glycemic Control Among Insured US Adults. JAMA Netw Open. 2023;6(10):e2336307. doi:10.1001/jamanetworkopen.2023.36307
- Campbell P. Rates of type 1 and type 2 diabetes in children increasing across the US. HCP Live. August 24, 2021. Accessed October 17, 2023. https://www.hcplive.com/view/rates-of-type-1-and-type-2-diabetes-in-children-increasing-across-the-us.