title: Limited health care access impairs glycemic control in low income urban African Americans with type 2 diabetes.
abstract: Limited access to health care is associated with adverse outcomes, but few studies have examined its effect on glycemic control in minority populations. Our observational cross-sectional study examined whether differences in health care access affected hemoglobin A1c (HbA1c) levels in 605 patients with diabetes (56% women; 89% African American; average age, 50 years; 95% with type 2 diabetes) initially treated at a municipal diabetes clinic. Patients who had difficulty obtaining care had higher A1c levels (9.4% vs. 8.7%; p=0.001), as did patients who used acute care facilities (9.5%; p<0.001) or who had no usual source of care (10.3%; p<0.001) compared with those who sought care at doctors' offices or clinics (8.6%). In adjusted analyses, HbA1c was higher in persons who gave a history of trouble obtaining medical care (0.57%; p=0.04), among persons who primarily used an acute care facility to receive their health care (0.49%; p=0.047), and in patients who reported not having a usual source of care (1.08%; p=0.009). Policy decisions for improving diabetes outcomes should target barriers to health care access and focus on developing programs to help high-risk populations maintain a regular place of health care.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia, USA. mrhee@emory.edu
authors.forename: Mary K
authors.initials: MK
authors.lastname: Rhee
authors.forename: Curtiss B
authors.initials: CB
authors.lastname: Cook
authors.forename: Virginia G
authors.initials: VG
authors.lastname: Dunbar
authors.forename: Rita M
authors.initials: RM
authors.lastname: Panayioto
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Berkowitz
authors.forename: Barbara
authors.initials: B
authors.lastname: Boyd
authors.forename: Christopher D
authors.initials: CD
authors.lastname: George
authors.forename: Robert H
authors.initials: RH
authors.lastname: Lyles
authors.forename: Imad M
authors.initials: IM
authors.lastname: El-Kebbi
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
mesh_terms: D001741:Black or African American; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000208:ethnology* / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D014504:Urban Health; D014505:Urban Population
chemical_list: D006442:Glycated Hemoglobin