Racial and Ethnic Disparities in Diabetes Care Quality among Women of Reproductive Age in an Integrated Delivery System |
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| Institution: | 1. School of Public Health, University of California, Berkeley, Berkeley, California;2. Division of Research, Kaiser Permanente Northern California, Oakland, California;1. Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas;2. Population Research Center and the Department of Sociology, University of Texas at Austin, Austin, Texas;3. Department of Health Care Organization & Policy, University of Alabama at Birmingham, Birmingham, Alabama;4. Jackson Women''s Health Organization, Jackson, Mississippi;1. Ibis Reproductive Health, Cambridge, Massachusetts;2. Office of Population Research, Princeton University, Princeton University, Princeton, New Jersey;3. Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California;1. Department of Research and Sponsored Programs, Children''s Hospitals and Clinics of Minnesota, Minneapolis, MN;2. Department of Quality and Safety, Children''s Hospitals and Clinics of Minnesota, Minneapolis, MN;1. Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California;2. Department of Obstetrics and Gynecology, University of California Irvine, Orange, California;3. School of Social Sciences, Humanities, and Arts, Department of Public Health, University of California, Merced, California;4. Department of Human Ecology, University of California, Davis, Davis, California;5. School of Medicine, University of California San Francisco, San Francisco, California;6. Department of Obstetrics and Gynecology, Fresno Medical Education Program, University of California San Francisco, Fresno, California;1. Southcentral Foundation Research Department, 4105 Tudor Centre Drive, Suite 200, Anchorage, AK 99508, USA;2. Institute for Circumpolar Health Studies, University of Alaska Anchorage, 3211 Providence Drive DPL 404, Anchorage, AK 99508, USA;1. Departments of Emergency Medicine and Health Policy, George Washington University, Washington, DC;2. Research Triangle International, Research Triangle Park, NC;3. Department of Applied Econometrics, University of North Carolina at Greensboro, Greensboro, NC;4. Mathematica Policy Research, Washington, DC |
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| Abstract: | BackgroundDiabetes is increasingly prevalent among women of reproductive age, yet little is known about quality of diabetes care for this population at increased risk of diabetes complications and poor maternal and infant health outcomes. Previous studies have identified racial/ethnic disparities in diabetes care, but patterns among women of reproductive age have not been examined.MethodsThis retrospective cohort study analyzed 2016 data from Kaiser Permanente Northern California, a large integrated delivery system. Outcomes were quality of diabetes care measures—glycemic testing, glycemic control, and medication adherence—among women ages 18 to 44 with type 1 or type 2 diabetes (N = 9,923). Poisson regression was used to estimate the association between patient race/ethnicity and each outcome, adjusting for other patient characteristics and health care use.ResultsIn this cohort, 83% of participants had type 2 diabetes; 31% and 36% of women with type 2 and type 1 diabetes, respectively, had poor glycemic control (hemoglobin A1c of ≥9%), and approximately one-third of women with type 2 diabetes exhibited nonadherence to diabetes medications. Compared with non-Hispanic White women with type 2 diabetes, non-Hispanic Black women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1–1.3) and Hispanic women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1–1.3) were more likely to have poor control. Findings among women with type 1 diabetes were similar.ConclusionsOur findings indicate opportunities to decrease disparities and improve quality of diabetes care for reproductive-aged women. Elucidating the contributing factors to poor glycemic control and medication adherence in this population, particularly among Black, Hispanic, and Asian women, should be a high research and practice priority. |
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