Beyond Race Disparities: Accounting for Socioeconomic Status in Diabetes Self-Care.

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  • Additional Information
    • Source:
      Publisher: Elsevier Science Country of Publication: Netherlands NLM ID: 8704773 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2607 (Electronic) Linking ISSN: 07493797 NLM ISO Abbreviation: Am J Prev Med Subsets: MEDLINE
    • Publication Information:
      Publication: Amsterdam : Elsevier Science
      Original Publication: [New York, NY] : Oxford University Press, [c1985-
    • Subject Terms:
      Health Literacy* ; Health Status Disparities* ; Self Care* ; Socioeconomic Factors*; Diabetes Mellitus, Type 2/*epidemiology; Black People/statistics & numerical data ; Diabetes Mellitus, Type 2/blood ; Feeding Behavior/ethnology ; Female ; Glycated Hemoglobin/analysis ; Humans ; Male ; Middle Aged ; Prevalence ; Randomized Controlled Trials as Topic ; United States ; White People/statistics & numerical data ; Black or African American
    • Abstract:
      Introduction: Among patients with type 2 diabetes, racial disparities are prevalent across a variety of outcomes; however, inconsistent disparities in determinants of outcomes warrants exploring the impact of other, related factors. This study sought to examine whether disparities in health literacy, numeracy, self-care behaviors, and HbA1c persisted between non-Hispanic blacks and non-Hispanic whites after applying a robust adjustment for socioeconomic status (SES).
      Methods: From 2016 to 2018, adult patients with type 2 diabetes (N=444) were recruited from primary care clinics. Participants self-reported demographics; indicators of SES (i.e., income, education, health insurance, housing status, and financial strain); subjective health literacy and numeracy; and self-care behaviors. Participants also completed an HbA1c test. In 2018, differences were examined between non-Hispanic blacks and non-Hispanic whites in health literacy, numeracy, self-care, and HbA1c, first unadjusted and then adjusted using propensity score weighting.
      Results: In unadjusted analyses, compared with non-Hispanic whites, non-Hispanic blacks had lower health literacy (p=0.039) and numeracy (p<0.001); less medication adherence (p=0.009); use of information for dietary decisions (p=0.013); and problem eating behaviors (p<0.001; i.e., non-Hispanic blacks reported fewer problems); and higher HbA1c levels (p=0.005). After adjusting for all SES indicators, only the reverse disparity in problem eating behaviors (p=0.016) and the disparity in HbA1c (p=0.011) remained.
      Conclusions: Findings highlight the importance of considering SES when examining disparities in health-related skills and behaviors. Moving beyond education and income to inclusion of more comprehensive markers of SES can improve understanding of how SES may contribute to disparities and the ability to appropriately target factors leading to inequality.
      (Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)
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    • Grant Information:
      K01 DK106306 United States DK NIDDK NIH HHS; K12 HL137943 United States HL NHLBI NIH HHS; R01 DK100694 United States DK NIDDK NIH HHS
    • Accession Number:
      0 (Glycated Hemoglobin A)
    • Publication Date:
      Date Created: 20190528 Date Completed: 20200710 Latest Revision: 20240712
    • Publication Date:
      20240712
    • Accession Number:
      PMC6589128
    • Accession Number:
      10.1016/j.amepre.2019.02.013
    • Accession Number:
      31130463