Gender and racial disparities in the management of diabetes mellitus among Medicare patients.
BACKGROUND
Racial/ethnic disparities in diabetes care have been demonstrated in several settings, but few studies have evaluated whether racial/ethnic differences vary by gender. The objective of this study is to understand gender and racial effects on diabetes care for Medicare managed care beneficiaries.


METHODS
Using data from: (1) Healthcare Effectiveness Data and Information Set (HEDIS); (2) Medicare Enrollment Files; and (3) U.S. Census, hierarchical generalized linear analyses were conducted to model the six HEDIS comprehensive diabetes care quality indicators, including processes of care and intermediate outcome measures, as a function of gender and race/ethnicity.


RESULTS
Women were more likely to have received HbA(1c) screening or eye examination, but less likely to have LDL control at <100 mg/dL, compared to men. Racial disparities favored whites in five measures, where African Americans were less likely to have received HbA(1c) screening, eye examination, cholesterol screening, or achieve adequate HbA(1c) control or LDL control at <100 mg/dL. Enrollees in managed care plans where African Americans constituted more than 20% of their insured population tended to have lower likelihood of meeting the HbA(1c) screening, HbA(1c) control, and eye examination measures.


CONCLUSIONS
Gender and racial disparities in performance indicators were present among persons enrolled in Medicare managed care. White women were more likely to have met the performance measures related to process of care, but African Americans fared worse in both process of care and intermediate health outcome measures, compared to their white counterparts. Poor performance in cholesterol control observed in women of both races suggests the possibility of less intensive cholesterol treatment in women. The differences in the pattern of care demonstrate the need for interventions tailored to address gender and race/ethnicity.
Chou
Ann F
AF
Department of Health Administration and Policy, College of Public Health and College of Medicine, University of Oklahoma, 801 NE 13th Street, Oklahoma City, OK 73120, USA. ann-chou@ouhsc.edu
Brown
Arleen F
AF
Jensen
Roxanne E
RE
Shih
Sarah
S
Pawlson
Greg
G
Scholle
Sarah Hudson
SH
D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D016387:Women's Health; D014932:Women's Health Services / Q000458:organization & administration
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin