Racial and ethnic disparities in the control of cardiovascular disease risk factors in Southwest American veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study

Persistent Link:
http://hdl.handle.net/10150/610033
Title:
Racial and ethnic disparities in the control of cardiovascular disease risk factors in Southwest American veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study
Author:
Wendel, Christopher; Shah, Jayendra; Duckworth, William; Hoffman, Richard; Mohler, M. J.; Murata, Glen
Affiliation:
Southern Arizona VA Health Care System, Tucson, AZ, 85723, USA; University of Arizona College of Medicine, Tucson, AZ, 85724, USA; Carl T. Hayden VA Medical Center, Phoenix, AZ, 85012, USA; New Mexico VA Health Care System, Albuquerque, NM, 87108, USA; University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA
Issue Date:
2006
Publisher:
BioMed Central
Citation:
BMC Health Services Research 2006, 6:58 doi:10.1186/1472-6963-6-58
Journal:
BMC Health Services Research
Rights:
© 2006 Wendel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)
Collection Information:
This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.
Abstract:
BACKGROUND:Racial/ethnic disparities in cardiovascular disease complications have been observed in diabetic patients. We examined the association between race/ethnicity and cardiovascular disease risk factor control in a large cohort of insulin-treated veterans with type 2 diabetes.METHODS:We conducted a cross-sectional observational study at 3 Veterans Affairs Medical Centers in the American Southwest. Using electronic pharmacy databases, we randomly selected 338 veterans with insulin-treated type 2 diabetes. We collected medical record and patient survey data on diabetes control and management, cardiovascular disease risk factors, comorbidity, demographics, socioeconomic factors, psychological status, and health behaviors. We used analysis of variance and multivariate linear regression to determine the effect of race/ethnicity on glycemic control, insulin treatment intensity, lipid levels, and blood pressure control.RESULTS:The study cohort was comprised of 72 (21.3%) Hispanic subjects (H), 35 (10.4%) African Americans (AA), and 226 (67%) non-Hispanic whites (NHW). The mean (SD) hemoglobin A1c differed significantly by race/ethnicity: NHW 7.86 (1.4)%, H 8.16 (1.6)%, AA 8.84 (2.9)%, p = 0.05. The multivariate-adjusted A1c was significantly higher for AA (+0.93%, p = 0.002) compared to NHW. Insulin doses (unit/day) also differed significantly: NHW 70.6 (48.8), H 58.4 (32.6), and AA 53.1 (36.2), p < 0.01. Multivariate-adjusted insulin doses were significantly lower for AA (-17.8 units/day, p = 0.01) and H (-10.5 units/day, p = 0.04) compared to NHW. Decrements in insulin doses were even greater among minority patients with poorly controlled diabetes (A1c greater than or equal to] 8%). The disparities in glycemic control and insulin treatment intensity could not be explained by differences in age, body mass index, oral hypoglycemic medications, socioeconomic barriers, attitudes about diabetes care, diabetes knowledge, depression, cognitive dysfunction, or social support. We found no significant racial/ethnic differences in lipid or blood pressure control.CONCLUSION:In our cohort, insulin-treated minority veterans, particularly AA, had poorer glycemic control and received lower doses of insulin than NHW. However, we found no differences for control of other cardiovascular disease risk factors. The diabetes treatment disparity could be due to provider behaviors and/or patient behaviors or preferences. Further research with larger sample sizes and more geographically diverse populations are needed to confirm our findings.
EISSN:
1472-6963
DOI:
10.1186/1472-6963-6-58
Version:
Final published version
Additional Links:
http://www.biomedcentral.com/1472-6963/6/58

Full metadata record

DC FieldValue Language
dc.contributor.authorWendel, Christopheren
dc.contributor.authorShah, Jayendraen
dc.contributor.authorDuckworth, Williamen
dc.contributor.authorHoffman, Richarden
dc.contributor.authorMohler, M. J.en
dc.contributor.authorMurata, Glenen
dc.date.accessioned2016-05-20T08:57:00Z-
dc.date.available2016-05-20T08:57:00Z-
dc.date.issued2006en
dc.identifier.citationBMC Health Services Research 2006, 6:58 doi:10.1186/1472-6963-6-58en
dc.identifier.doi10.1186/1472-6963-6-58en
dc.identifier.urihttp://hdl.handle.net/10150/610033-
dc.description.abstractBACKGROUND:Racial/ethnic disparities in cardiovascular disease complications have been observed in diabetic patients. We examined the association between race/ethnicity and cardiovascular disease risk factor control in a large cohort of insulin-treated veterans with type 2 diabetes.METHODS:We conducted a cross-sectional observational study at 3 Veterans Affairs Medical Centers in the American Southwest. Using electronic pharmacy databases, we randomly selected 338 veterans with insulin-treated type 2 diabetes. We collected medical record and patient survey data on diabetes control and management, cardiovascular disease risk factors, comorbidity, demographics, socioeconomic factors, psychological status, and health behaviors. We used analysis of variance and multivariate linear regression to determine the effect of race/ethnicity on glycemic control, insulin treatment intensity, lipid levels, and blood pressure control.RESULTS:The study cohort was comprised of 72 (21.3%) Hispanic subjects (H), 35 (10.4%) African Americans (AA), and 226 (67%) non-Hispanic whites (NHW). The mean (SD) hemoglobin A1c differed significantly by race/ethnicity: NHW 7.86 (1.4)%, H 8.16 (1.6)%, AA 8.84 (2.9)%, p = 0.05. The multivariate-adjusted A1c was significantly higher for AA (+0.93%, p = 0.002) compared to NHW. Insulin doses (unit/day) also differed significantly: NHW 70.6 (48.8), H 58.4 (32.6), and AA 53.1 (36.2), p < 0.01. Multivariate-adjusted insulin doses were significantly lower for AA (-17.8 units/day, p = 0.01) and H (-10.5 units/day, p = 0.04) compared to NHW. Decrements in insulin doses were even greater among minority patients with poorly controlled diabetes (A1c greater than or equal to] 8%). The disparities in glycemic control and insulin treatment intensity could not be explained by differences in age, body mass index, oral hypoglycemic medications, socioeconomic barriers, attitudes about diabetes care, diabetes knowledge, depression, cognitive dysfunction, or social support. We found no significant racial/ethnic differences in lipid or blood pressure control.CONCLUSION:In our cohort, insulin-treated minority veterans, particularly AA, had poorer glycemic control and received lower doses of insulin than NHW. However, we found no differences for control of other cardiovascular disease risk factors. The diabetes treatment disparity could be due to provider behaviors and/or patient behaviors or preferences. Further research with larger sample sizes and more geographically diverse populations are needed to confirm our findings.en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.relation.urlhttp://www.biomedcentral.com/1472-6963/6/58en
dc.rights© 2006 Wendel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)en
dc.titleRacial and ethnic disparities in the control of cardiovascular disease risk factors in Southwest American veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Studyen
dc.typeArticleen
dc.identifier.eissn1472-6963en
dc.contributor.departmentSouthern Arizona VA Health Care System, Tucson, AZ, 85723, USAen
dc.contributor.departmentUniversity of Arizona College of Medicine, Tucson, AZ, 85724, USAen
dc.contributor.departmentCarl T. Hayden VA Medical Center, Phoenix, AZ, 85012, USAen
dc.contributor.departmentNew Mexico VA Health Care System, Albuquerque, NM, 87108, USAen
dc.contributor.departmentUniversity of New Mexico School of Medicine, Albuquerque, NM, 87131, USAen
dc.identifier.journalBMC Health Services Researchen
dc.description.collectioninformationThis item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.en
dc.eprint.versionFinal published versionen
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