Sociodemographic disparities in the management of type 2 diabetes in the United States

Abstract

Objective

To examine the potential sociodemographic disparities in type 2 diabetes (T2D) management and care among US adult individuals, after controlling for clinical and behavioral factors.

Methods

This was a retrospective cohort study of individuals with T2D (N = 4552) from a linked database of the National Health and Wellness Survey and a large US ambulatory electronic health record (EHR) database. This study period was between 1 January 2015 and 31 December 2018 and individuals were followed up for at least 6 months through EHR after the completion of the survey. The sociodemographic characteristics included gender, race, ethnicity, marital status, education, employment status, household income, insurance status, and geographic region. The independent variables included testing and control of HbA1c, blood pressure (BP), and low-density lipoprotein-cholesterol (LDL-C); hypoglycemia, emergency room (ER) visits, and all-cause hospitalization. Multivariable analyses were conducted using generalized linear models.

Results

The percentage of uncontrolled HbA1c was 38.6%. With clinical and behavioral characteristics adjusted, individuals living in the Northeast region had 30% higher odds of having HbA1c testing than those who lived in the South. Blacks and Asians were less likely to have HbA1c control than Whites. Uninsured individuals had a lower likelihood of receiving HbA1c, BP, or LDL-C testing compared with commercial insurers. Individuals with low income were more likely to have higher ER visits and hospitalizations.

Conclusion

Potential sociodemographic disparities exist in T2D management and care in the US, indicating the needs for improvement in healthcare access, educational and behavioral programs, as well as disease and treatment management in these subgroups.

Keywords:

• Type 2 diabetes
• sociodemographic disparity
• health disparity
• HbA1c testing
• HbA1c control

Transparency

Declaration of funding

This work was supported by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Declaration of financial/other relationships

XT, MP, and SR are employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and stockholders of Merck & Co., Inc., Kenilworth, NJ, USA. LL and SH are employees of Kantar, NY, USA. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

XT, LL, MP, and SR were involved in the conception and design. MP was involved in data acquisition. All authors were involved in data analysis or interpretation of the results. All authors were involved in the drafting of the manuscript or critically reviewing or revising it critically for intellectual content. All authors approved the version to be published. All authors agree to be accountable for all aspects of the work.

Acknowledgements

The authors acknowledge Amit Koushik, MS and Ramu Periyasamy, PhD, Indegene Pvt Ltd. for assistance with literature review and medical writing.