Disturbing Diabetes Trends

By Barbara Hesselgrave, Miller-McCune.com. Posted November 27, 2008.

Federal officials were concerned after the 2006 National Healthcare Disparities Report confirmed growing disparities in health care among older Hispanics nationwide, in particular for diabetes.

It's no secret that diabetes -- a chronic condition that without proper care, particularly in older people, can result in blindness, amputation and death -- disproportionately affects Hispanic populations. The Centers for Disease Control and Prevention determined in 2005 that 10.2 percent of U.S. Hispanics would be diagnosed with diabetes, compared with 6.9 percent for (non-Hispanic) whites. Hispanics were 50 percent more likely to die from the disease than were whites.

Meanwhile, diabetes is a burgeoning health threat for all Americans -- the CDC announced today that the incidence of type 2 diabetes has almost doubled since 1997.

But the new report found disparities not in incidence but in care.

"Health disparity can be difficult to define, and, ultimately, the reasons may not always be known, but its effect -- lack of proper or appropriate care based upon standards -- is where we focus for change," said Dr. Ernest Moy, the medical officer in charge of data analysis for the Agency for Healthcare Research and Quality (AHRQ) Center for Quality Improvement and Patient Safety.

The Disparities report, compiled since 2005 from millions of anonymous patient records from public and private health sources, compares these findings to a standard of 150 quality-care measures. Moy said when the standards of care are not met -- "if children are not getting vision exams, or women are not being screened for mammograms, or people with chronic disease are not getting tests or taking their medicine properly" -- then that population is reported to have a health disparity.

The results echo a meta-analysis published in February's Diabetes Care journal. Lead author Julienne Kirk, associate professor of family and community medicine at the Wake Forest University School of Medicine, also was struck by the care disparity.

"We were not surprised by these findings since ethnic minorities in the U.S. are disproportionately affected by diabetes, and we found a similar trend in the African-American population with diabetes a year ago," she said in a press release announcing the study. "What did surprise us were the results of our analysis of subgroups of patients with managed care and non-managed care insurance. The largest difference for A1C (a blood test that identifies difficulty controlling their blood sugar) was among non-managed care insurance groups.

"A high percentage of Hispanics in this country have low incomes, no health insurance and limited access to health care. The Hispanic population has a high prevalence of diabetes and higher A1C than non-Hispanic whites. This further elucidates the health disparities that characterize the Hispanic population."

To address the persistent health disparities among elderly Hispanics, particularly in diabetes, the Department of Health and Human Services authorized a new federal collaborative called the Learning Network.

AHRQ spokeswoman Ellen Crown said the program, launched last year, includes technical assistance, education and outreach support from five federal groups: AHRQ, CDC, Agency on Aging, Center for Medicare and Medicaid Services and the Health Resources and Services Administration. The goal is to "create a unique program that cuts across traditional organization boundaries at the local level" to improve health care delivery for elderly Hispanics.

Moy said that while prevention is the best way to achieve better outcomes, insurers frequently won't invest in it because the payoff often comes after individuals leave specific insurance companies or migrate to public health plans. But while people may change insurers or go to Medicare, they're likely to remain in the same community, which makes community partnering a great way to close the gap in care.

The collaboration targeted several regions with large Hispanic populations: New York City, Chicago, Miami, Houston, San Antonio and the Lower Rio Grande, San Diego and Los Angeles. "Each of our eight target communities is a unique cultural scenario -- what works in New York may fail in Miami," Crown said. The participants could select their area of disease focus but most chose diabetes care.

See more stories tagged with: health, health care, diabetes, health disparities, hispanic populations

Barbara Hesselgrave is a freelance writer in Virginia specializing in issues of community medicine, science and international health.

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