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Self-reported Racial Discrimination in Health Care and Diabetes Outcomes

Peek, Monica E. MD, MPH*,†,‡,§,∥; Wagner, Julie PhD; Tang, Hui MS, MS†,‡; Baker, Dustyn C. MD*,♯; Chin, Marshall H. MD, MPH*,†,‡,∥

doi: 10.1097/MLR.0b013e318215d925
Original Articles

Background: Self-reported racial discrimination in healthcare has been associated with negative health outcomes, but little is known about its association with diabetes outcomes.

Methods: We used data from the Behavioral Risk Factor Surveillance System to investigate associations between self-reported healthcare discrimination and the following diabetes outcomes: (1) quality of care, (2) self-management and (3) complications.

Results: In unadjusted logistic regression models, significant associations were found between self-reported healthcare discrimination and most measures of quality of care [diabetes-related primary care visits odds ratio (OR), 0.38; 95% confidence interval (CI), 0.21-0.66), HbA1c testing (OR, 0.42; 95%CI, 0.21-0.82), and earlier eye examination interval (OR, 0.48; 95% CI, 0.24-0.93)] and health outcomes [foot disorders (OR, 2.32, 95%CI: 1.15, 4.68) and retinopathy (OR, 2.26; 95%CI, 1.24-4.12)], but not the number of provider foot examinations (P=0.48) or diabetes self-management (self glucose monitoring, P=0.42; self foot examinations, P=0.74; diabetes class participation, P=0.37). The effects of self-reported discrimination were attenuated or eliminated after controlling for sociodemographics, health status, and access to care.

Conclusions: Self-reported racial/ethnic discrimination in healthcare was associated with worse diabetes care and more diabetes complications, but not self-care behaviors, suggesting that factors beyond patients' own behaviors may be the main source of differential outcomes. The relationships between self-reported discrimination and diabetes outcomes were eliminated once adjusting for sociodemographics, health status, and access to care. Our findings suggest that other factors (ie, race, insurance, health status) may play equally or more important roles in determining diabetes health disparities, and that a comprehensive strategy is needed to effectively address health disparities.

*Section of General Internal Medicine, Department of Medicine

Diabetes Research and Training Center

Center for Health and Social Sciences

§Center for the Study of Race, Politics and Culture

MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL

Division of Behavioral Sciences and Community Health, University of Connecticut, City, Farmington, CT

Harvard Medical School, Boston, MA

Supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diabetes Research and Training Center (P60 DK20595). Dr Peek is supported by the Robert Wood Johnson Foundation, Harold Amos Medical Faculty Development program and the Mentored Patient-Oriented Career Development Award of the National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK075006-01). Dr Wagner is supported by grants from the American Heart Association and NIDDK (R21 DK074468). Support for Dr Chin is provided by a Midcareer Investigator Award in Patient-Oriented Research from the NIDDK (K24 DK071933-01).

Reprints: Monica E. Peek, MD, MPH, The University of Chicago, Section of General Internal Medicine, 5841 S. Maryland, MC 2007, Chicago, IL 60637. e-mail: mpeek@medicine.bsd.uchicago.edu.

© 2011 Lippincott Williams & Wilkins, Inc.