Racial differences in spatial patterns for poor glycemic control in the Southeastern United States.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 9100013 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2585 (Electronic) Linking ISSN: 10472797 NLM ISO Abbreviation: Ann Epidemiol Subsets: MEDLINE
    • Publication Information:
      Original Publication: New York, NY : Elsevier, c1990-
    • Subject Terms:
      Spatial Analysis*; Black People/*statistics & numerical data ; Diabetes Mellitus, Type 2/*ethnology ; Hispanic or Latino/*statistics & numerical data ; Insulin/*administration & dosage ; Veterans/*statistics & numerical data; Aged ; Aged, 80 and over ; Alabama ; Blood Glucose ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/epidemiology ; Female ; Georgia ; Glycated Hemoglobin/analysis ; Glycated Hemoglobin/metabolism ; Humans ; Hypoglycemic Agents/therapeutic use ; Insulin/therapeutic use ; Male ; Middle Aged ; Prevalence ; South Carolina ; United States/epidemiology ; Veterans/psychology ; Black or African American
    • Abstract:
      Purpose: Evidence consistently shows poor outcomes in racial minorities, but there is limited understanding of differences that are explained by spatial variation. The goal of this analysis was to examine contribution of spatial patterns on disparities in diabetes outcomes in the Southeastern United States.
      Methods: Data on 64,022 non-Hispanic black (NHB) and non-Hispanic white (NHW) veterans with diabetes living in Georgia, Alabama, and South Carolina were analyzed for 2014. Hemoglobin A1c (HbA1c) was categorized as controlled (less than 8%) and uncontrolled (greater than or equal to 8%). Logistic regression was used to understand the additional explanatory capability of spatial random effects over covariates such as demographics, service connectedness, and comorbidities. Data aggregated at the county level were used to identify hotspots in distribution of uncontrolled HbA1c and tested using local Moran's I test.
      Results: Overall percent uncontrolled HbA1c was 36.5% (40.8% in NHB and 33.4% in NHW). In unadjusted analyses, NHB had 37% higher odds of uncontrolled HbA1c (odds ratio [OR]: 1.37, 95% confidence interval, 1.32, 1.41). After adjusting for demographics and comorbidities, the OR decreased to 1.09 but remained significant (95% confidence interval, 1.05, 1.13). The OR further decreased after incorporating spatial effects (OR: 1.07, 95% confidence interval, 1.03, 1.11) but remained statistically significant. Hotspots of high HbA1c were detected, and spatial patterns differed across racial groups.
      Conclusions: Differences in spatial patterns in glycemic control exists between NHB and NHW veterans with type 2 diabetes. Incorporating spatial effects helps explain more of the disparity in uncontrolled HbA1c than adjusting only for demographics and comorbidities, but significant differences in uncontrolled HbA1c remained.
      (Copyright © 2018 Elsevier Inc. All rights reserved.)
    • References:
      Int J Health Geogr. 2014 Nov 20;13:47. (PMID: 25410053)
      Soc Sci Med. 2012 Apr;74(7):1082-90. (PMID: 22373821)
      Med Clin North Am. 2005 Sep;89(5):949-75, viii. (PMID: 16129107)
      Am J Public Health. 2012 Feb;102(2):343-51. (PMID: 22390449)
      BMJ Open. 2012 Feb 15;2(1):e000711. (PMID: 22337817)
      Prev Chronic Dis. 2015 Jan 22;12:E08. (PMID: 25611797)
      Health Syst Rev. 1996 May-Jun;29(3):44-5, 47. (PMID: 10158559)
      Ethn Dis. 2009 Spring;19(2):179-84. (PMID: 19537230)
      Soc Sci Med. 2007 Nov;65(9):1953-64. (PMID: 17719709)
      Ann N Y Acad Sci. 2010 Feb;1186:125-45. (PMID: 20201871)
      Ann Epidemiol. 2013 Aug;23(8):504-14. (PMID: 23830932)
      Public Health Rep. 2001 Sep-Oct;116(5):404-16. (PMID: 12042604)
      Diabetes Res Clin Pract. 2010 Mar;87(3):302-12. (PMID: 20181405)
      Diabetes Forecast. 2014 Dec;67(12):44-7. (PMID: 25872365)
      Am J Med Sci. 2016 Apr;351(4):366-73. (PMID: 27079342)
      Med Care Res Rev. 2016 Aug;73(4):493-507. (PMID: 26589675)
      Diabetes Care. 2004 May;27 Suppl 2:B10-21. (PMID: 15113777)
      Ann Pharmacother. 2011 Feb;45(2):169-78. (PMID: 21304026)
      Healthc Inform Res. 2012 Jun;18(2):88-96. (PMID: 22844644)
      Ethn Dis. 2015 Nov 05;25(4):521-4. (PMID: 26673674)
      Diabetes Care. 2016 Sep;39(9):1556-62. (PMID: 27555622)
      Human Geogr. 2012;6(2):5-13. (PMID: 25414731)
      Med Care. 2010 Jun;48(6):527-33. (PMID: 20473215)
      J Rural Health. 2010 Fall;26(4):301-9. (PMID: 21029164)
      Diabetes Care. 2011 Apr;34(4):938-43. (PMID: 21335370)
      Health Serv Res. 2002 Oct;37(5):1159-80. (PMID: 12479491)
      Am J Epidemiol. 2007 Aug 15;166(4):379-87. (PMID: 17625220)
      Med Care. 2005 Nov;43(11):1130-9. (PMID: 16224307)
      Endocrine. 2012 Dec;42(3):471-82. (PMID: 22815042)
      J Clin Epidemiol. 2007 Jan;60(1):86-93. (PMID: 17161759)
      Diabetes Care. 2006 Sep;29(9):2130-6. (PMID: 16936167)
      N Engl J Med. 2013 Jul 18;369(3):287-8. (PMID: 23863067)
      Health Serv Res. 2005 Dec;40(6 Pt 1):1818-35. (PMID: 16336550)
      Ann Epidemiol. 2013 Feb;23(2):74-9. (PMID: 23238350)
    • Grant Information:
      I50 HX001229 United States HX HSRD VA; K24 DK093699 United States DK NIDDK NIH HHS
    • Contributed Indexing:
      Keywords: Diabetes; Disparities; Racial/ethnic differences; Spatial variation
    • Accession Number:
      0 (Blood Glucose)
      0 (Glycated Hemoglobin A)
      0 (Hypoglycemic Agents)
      0 (Insulin)
    • Publication Date:
      Date Created: 20180206 Date Completed: 20190410 Latest Revision: 20240712
    • Publication Date:
      20240712
    • Accession Number:
      PMC5828989
    • Accession Number:
      10.1016/j.annepidem.2018.01.008
    • Accession Number:
      29398299