Racial/ethnic differences in the healthcare experience (coverage, utilization, and satisfaction) of US adults with diabetes.
OBJECTIVE
To examine racial/ethnic differences in healthcare coverage, utilization, and satisfaction, among US adults with diabetes.


METHODS
We conducted a cross-sectional analysis among 9443 adults with diabetes who participated in the 1999 Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey of the civilian non-institutionalized US population aged > or = 18 yrs.


METHODS
We compared healthcare coverage, utilization, and satisfaction across 4 race/ethnicity categories: non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), Hispanics (HSP), and others, and examined whether these factors were associated with self-rated health status.


RESULTS
By self-report, more NHB (14.8%), HSP (20.7%), and members of other races (21.8%) were uninsured, compared to NHW (6.4%). Similarly, cost was a barrier to visiting a doctor for 23.9% of HSP, 19.5% of NHB, and 13.4% of members of other races; however, only 8.2% of non-Hispanic Whites reported cost as a barrier. More NHW (90.1%) and NHB (90.7) reported having had a check-up in the past year, compared to HSP (84.5%) or others (84.1%). All 3 variables exhibited significant differences by race or ethnicity (all P<.01). After adjustment for age, sex, income, education, and insulin use, the association with race/ethnicity persisted for health insurance coverage (P<.001), and for cost as a barrier (P<.003). Reporting cost as a barrier to visiting a doctor (P=.013), and rating one's overall health care as fair or poor (P=.001), were associated with poorer health status.


CONCLUSIONS
These results suggest that ethnic minorities with diabetes report less healthcare coverage and more cost-related barriers to utilization, compared to non-Hispanic Whites. Persons with fair/poor health status were more likely to report cost barriers and poor satisfaction. Future research should focus on the reasons for such differences and on interventions to improve health care for minority populations.
Gary
Tiffany L
TL
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. tgary@jhsph.edu
Narayan
K M Venkat
KM
Gregg
Edward W
EW
Beckles
Gloria L A
GL
Saaddine
Jinan B
JB
D000328:Adult; D001741:Black or African American; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000208:ethnology*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D044465:White People