Racial differences in diabetes self-management and quality of care in Texas.
OBJECTIVE
To assess racial/ethnic differences in diabetes self-management behaviors and quality of care in Texas.


METHODS
This cross-sectional study assessed self-management behaviors and quality of care in 1720 adults with diabetes in the 2002-2004 Texas Behavioral Risk Factor Surveillance Survey. Multiple logistic regression models were used for assessing the independent association between race/ethnicity, self-management behaviors, and quality of care variables controlling for covariates. SAS (SAS Institute Inc, 2002-2003) was used for statistical analysis.


RESULTS
Eighteen percent of Hispanics, 14% of Blacks, and 10% of Whites reported never performing home glucose testing. Seventeen percent of Hispanics, 11% of Blacks, and 10% of Whites reported never doing home foot exam. Thirty-two percent of Hispanics, 21% of Blacks, and 16% of Whites did not have an A1C test in the prior 12 months. Twelve percent of Hispanics, 10% of Blacks, and 6% of Whites did not have a dilated eye exam in the prior 12 months. Fifty-four percent of Whites, 42% of Blacks, and 40% of Hispanics received a flu shot. Forty-nine percent of Whites, 30% of Blacks, and 26% of Hispanics received a pneumonia shot. In adjusted models, Hispanics were more likely to be sedentary (OR, 1.64; 95% CI, 1.08-2.49) compared to Whites. Blacks did not differ significantly from Whites (OR, 1.46; 95% CI, 0.92-2.34). Hispanics (OR, 1.61; 95% CI, 1.01-2.57) and Blacks (OR, 1.83; 95% CI, 1.10-3.03) were more likely to get an annual foot exam by a provider compared to Whites. Hispanics (OR, 0.54; 95% CI, 0.34-0.85) and Blacks (OR, 0.58; 95% CI, 0.35-0.98) were less likely to get a pneumonia shot compared to Whites.


CONCLUSIONS
Hispanics have poorer access to care and poorer health status compared to Whites or Blacks. Controlling for socioeconomic and access to care variables eliminated disparities in self-management but did not eliminate disparities in quality of diabetes care.
Nwasuruba
Chiagozie
C
Department of Medicine, University of Texas Health Center at Tyler, TX, USA.
Osuagwu
Christie
C
Bae
Sejong
S
Singh
Karan P
KP
Egede
Leonard E
LE
D000293:Adolescent; D000328:Adult; D000368:Aged; D044383:Black People; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000523:psychology* / Q000534:rehabilitation; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D015438:Health Behavior; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D044469:Racial Groups; D012044:Regression Analysis; D012648:Self Care; D013781:Texas; D044465:White People; D055815:Young Adult; D001741:Black or African American