title: Self-reported racial discrimination in health care and diabetes outcomes.
abstract: BACKGROUND
  Self-reported racial discrimination in healthcare has been associated with negative health outcomes, but little is known about its association with diabetes outcomes.
  
  
  METHODS
  We used data from the Behavioral Risk Factor Surveillance System to investigate associations between self-reported healthcare discrimination and the following diabetes outcomes: (1) quality of care, (2) self-management and (3) complications.
  
  
  RESULTS
  In unadjusted logistic regression models, significant associations were found between self-reported healthcare discrimination and most measures of quality of care [diabetes-related primary care visits odds ratio (OR), 0.38; 95% confidence interval (CI), 0.21-0.66), HbA1c testing (OR, 0.42; 95%CI, 0.21-0.82), and earlier eye examination interval (OR, 0.48; 95% CI, 0.24-0.93)] and health outcomes [foot disorders (OR, 2.32, 95%CI: 1.15, 4.68) and retinopathy (OR, 2.26; 95%CI, 1.24-4.12)], but not the number of provider foot examinations (P=0.48) or diabetes self-management (self glucose monitoring, P=0.42; self foot examinations, P=0.74; diabetes class participation, P=0.37). The effects of self-reported discrimination were attenuated or eliminated after controlling for sociodemographics, health status, and access to care.
  
  
  CONCLUSIONS
  Self-reported racial/ethnic discrimination in healthcare was associated with worse diabetes care and more diabetes complications, but not self-care behaviors, suggesting that factors beyond patients' own behaviors may be the main source of differential outcomes. The relationships between self-reported discrimination and diabetes outcomes were eliminated once adjusting for sociodemographics, health status, and access to care. Our findings suggest that other factors (ie, race, insurance, health status) may play equally or more important roles in determining diabetes health disparities, and that a comprehensive strategy is needed to effectively address health disparities.
authors.affiliation: Section of General Internal Medicine, Department of Medicine, University of Chicago, IL, USA. mpeek@medicine.bsd.uchicago.edu
authors.forename: Monica E
authors.initials: ME
authors.lastname: Peek
authors.forename: Julie
authors.initials: J
authors.lastname: Wagner
authors.forename: Hui
authors.initials: H
authors.lastname: Tang
authors.forename: Dustyn C
authors.initials: DC
authors.lastname: Baker
authors.forename: Marshall H
authors.initials: MH
authors.lastname: Chin
mesh_terms: D040343:Behavioral Risk Factor Surveillance System; D048909:Diabetes Complications / Q000208:ethnology*; D003920:Diabetes Mellitus / Q000208:ethnology*; D003941:Diagnostic Techniques, Ophthalmological / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006304:Health Status; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011287:Prejudice; D011787:Quality of Health Care / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data*; D012648:Self Care / Q000706:statistics & numerical data; D057566:Self Report; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D006442:Glycated Hemoglobin