Race, ethnicity, socioeconomic position, and quality of care for adults with diabetes enrolled in managed care: the Translating Research Into Action for Diabetes (TRIAD) study.
OBJECTIVE
To examine racial/ethnic and socioeconomic variation in diabetes care in managed-care settings.


METHODS
We studied 7,456 adults enrolled in health plans participating in the Translating Research Into Action for Diabetes study, a six-center cohort study of diabetes in managed care. Cross-sectional analyses using hierarchical regression models assessed processes of care (HbA(1c) [A1C], lipid, and proteinuria assessment; foot and dilated eye examinations; use or advice to use aspirin; and influenza vaccination) and intermediate health outcomes (A1C, LDL, and blood pressure control).


RESULTS
Most quality indicators and intermediate outcomes were comparable across race/ethnicity and socioeconomic position (SEP). Latinos and Asians/Pacific Islanders had similar or better processes and intermediate outcomes than whites with the exception of slightly higher A1C levels. Compared with whites, African Americans had lower rates of A1C and LDL measurement and influenza vaccination, higher rates of foot and dilated eye examinations, and the poorest blood pressure and lipid control. The main SEP difference was lower rates of dilated eye examinations among poorer and less educated individuals. In almost all instances, racial/ethnic minorities or low SEP participants with poor glycemic, blood pressure, and lipid control received similar or more appropriate intensification of therapy relative to whites or those with higher SEP.


CONCLUSIONS
In these managed-care settings, minority race/ethnicity was not consistently associated with worse processes or outcomes, and not all differences favored whites. The only notable SEP disparity was in rates of dilated eye examinations. Social disparities in health may be reduced in managed-care settings.
Brown
Arleen F
AF
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1736, USA. abrown@mednet.ucla.edu
Gregg
Edward W
EW
Stevens
Mark R
MR
Karter
Andrew J
AJ
Weinberger
Morris
M
Safford
Monika M
MM
Gary
Tiffany L
TL
Caputo
Dorothy A
DA
Waitzfelder
Beth
B
Kim
Catherine
C
Beckles
Gloria L
GL
D000328:Adult; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008875:Middle Aged; D011787:Quality of Health Care; D044469:Racial Groups; D012107:Research Design; D012959:Socioeconomic Factors; D014481:United States