title: Racial/ethnic differences in diabetes care for older veterans: accounting for dual health system use changes conclusions.
abstract: BACKGROUND
  Veterans Health Administration (VHA) databases are used extensively to study racial/ethnic disparities; however, these databases may not capture all care received by VHA patients.
  
  
  OBJECTIVE
  We examined the extent to which accounting for non-VHA care changed conclusions about racial/ethnic disparities for VHA patients with diabetes.
  
  
  METHODS
  Using a cross-sectional observational study, we analyzed a national sample of noninstitutionalized Hispanic (n = 5931), black (n = 24,670), and white (n = 149,222) VHA patients with diabetes who were at least 65 years of age for receipt of annual HbA1c testing, low-density lipoprotein (LDL) cholesterol testing, or eye examination from VHA and Medicare administrative files.
  
  
  RESULTS
  In VHA alone data, adjusting for patient characteristics, Hispanic and black patients were as likely as white patients to receive HbA1c testing (odds ratio 1.06 [95% confidence interval 0.99-1.13] and 1.04 [1.00-1.07], respectively), and more likely to receive eye examinations (1.31 [1.24-1.38] and 1.33 [1.29-1.37], respectively). Hispanic patients were equally likely (1.01 [0.95-1.07]) and black patients were less likely (0.81 [0.79-0.84]) to receive LDL testing versus white patients. In VHA plus Medicare data, Hispanic and black patients were less likely than white patients to receive HbA1c (0.76 [0.71-0.82] and 0.83 [0.80-0.87], respectively) and LDL testing (0.84 [0.79-0.90] and 0.70 [0.68-0.72], respectively), and equally likely to receive eye examinations (0.91 [0.86-0.96]) and 0.98 [0.95-1.01]), respectively). Accounting for VHA facility had little effect on results.
  
  
  CONCLUSIONS
  Restricting to VHA data masks racial/ethnic disparities in care of VHA patients. VHA researchers must be aware and supplement VHA data with other sources whenever possible.
authors.affiliation: Center for Health Quality, Outcomes, and Economic Research, Bedford VA Hospital, Bedford, Massachusetts, USA. jhalanych@uab.edu
authors.forename: Jewell H
authors.initials: JH
authors.lastname: Halanych
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.forename: Donald R
authors.initials: DR
authors.lastname: Miller
authors.forename: Leonard M
authors.initials: LM
authors.lastname: Pogach
authors.forename: Hai
authors.initials: H
authors.lastname: Lin
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
authors.forename: Susan M
authors.initials: SM
authors.lastname: Frayne
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000097:blood / Q000175:diagnosis; D003920:Diabetes Mellitus / Q000097:blood / Q000208:ethnology* / Q000628:therapy*; D003941:Diagnostic Techniques, Ophthalmological / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin