The diabetes epidemic places a disproportionate burden on older adults and ethnic minorities in the United States. More than 25 percent of adults over the age of 60 have diabetes, and blacks and Hispanics suffer the disease at nearly twice the rate as whites.
Yet despite these differences, a new study shows that when older non-white adults with diabetes have equal access to health care, they report a better physical health-related quality of life than whites. This offers more evidence that improving access to care for chronic diseases like diabetes can help address longstanding disparities in care for minorities.
Neda Laiteerapong, MD, Marshall Chin, MD, MPH, Elbert Huang, MD, and colleagues from the University of Chicago Department of Medicine, University of California at San Francisco and the Kaiser Permanente Northern California Division of Research, examined survey data from a large group of insured, older adults with diabetes who receive care from the Kaiser Permanente health system in Northern California. The data included information about the patients’ general perception of their health and how it affects their daily activities. The results, published online this week in the Journal of the American Geriatrics Society, showed that Asians, Filipinos, Hispanics and blacks all reported better physical health-related quality of life than whites.Laiteerapong said that even when they adjusted for socioeconomic factors, these differences remained.
“When you adjust for sociodemographics, health behaviors and chronic diseases, the differences become smaller, but still present,” she said. “That suggests that if everyone was in the system then maybe that could solve some of the health disparities we have. Not everything, of course, but some things.”
Health-related quality of life is a concept used to describe how aspects of a person’s overall quality of life—such as happiness, social support, socioeconomic status and day-to-day activity and mobility—affect their physical or mental health. For this study the researchers used a modified, 8-question version of a standard 36-question tool developed in the 1980s.
Population-based studies of patients with and without private insurance, on Medicaid and Medicare, and with varying levels of access to care show that ethnic minorities generally have more health problems than whites, and have a higher risk of diabetes-related complications. But previous studies of the same population from the Kaiser Permanente system have shown that ethnic minorities had significantly lower rates of diabetes-related complications, such as heart failure and stroke than whites.
Laiteerapong said the lower rate of diabetes-related complications is probably due to differences in genetics and predispositions to complications, and might be a big reason for the better quality of life in the absence of other barriers to care. She plans to continue looking at more varied populations of older adults with diabetes on a national scale to see how access to care affects their quality of life.
But the results of this research help support the argument that when everyone has equal access to quality health care, many of the traditional ethnic disparities disappear.
“We were really happy with the results,” she said. “In a health care system where everyone has access, the playing field may be more even and quality of life could be better for everyone.”
- In September, Dr. Laiteerapong and her colleagues published a study on promoting individualized targets for blood glucose levels for diabetics.
- In November, Dr. Huang was part of a panel studying the implications of the growing population of older patients with type 2 diabetes.
Laiteerapong N., Karter A.J., John P.M., Schillinger D., Moffet H.H., Liu J.Y., Adler N., Chin M.H. & Huang E.S. (2013). Ethnic Differences in Quality of Life in Insured Older Adults with Diabetes Mellitus in an Integrated Delivery System, Journal of the American Geriatrics Society, n/a-n/a. DOI: 10.1111/jgs.12327