Identifying Risk Factors for Racial Disparities in Diabetes Outcomes: The Translating Research Into Action for Diabetes Study

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Abstract

Background:

Versus whites, blacks with diabetes have poorer control of hemoglobin A1c (HbA1c), higher systolic blood pressure (SBP), and higher low-density lipoprotein (LDL) cholesterol as well as higher rates of morbidity and microvascular complications.

Objective:

To examine whether several mutable risk factors were more strongly associated with poor control of multiple intermediate outcomes among blacks with diabetes than among similar whites.

Design:

Case-control study.

Subjects:

A total of 764 blacks and whites with diabetes receiving care within 8 managed care health plans.

Measures:

Cases were patients with poor control of at least 2 of 3 intermediate outcomes (HbA1c ≥8.0%, SBP ≥140 mmHg, LDL cholesterol ≥130 mg/dL) and controls were patients with good control of all 3 (HbA1c <8.0%, SBP <140 mmHg, LDL cholesterol <130 mg/dL). In multivariate analyses, we determined whether each of several potentially mutable risk factors, including depression, poor adherence to medications, low self-efficacy for reducing cardiovascular risk, and poor patient-provider communication, predicted case or control status.

Results:

Among blacks but not whites, in multivariate analyses depression (odds ratio: 2.28; 95% confidence interval: 1.09–4.75) and having missed medication doses (odds ratio: 1.96; 95% confidence interval: 1.01–3.81) were associated with greater odds of being a case rather than a control. None of the other risk factors were associated for either blacks or whites.

Conclusions:

Depression and missing medication doses are more strongly associated with poor diabetes control among blacks than in whites. These 2 risk factors may represent important targets for patient-level interventions to address racial disparities in diabetes outcomes.

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