title: Do diabetic patients living in racially segregated neighborhoods experience different access and quality of care?
abstract: BACKGROUND
  Place of residence, particularly residential segregation, has been implicated in health and health care disparities. However, prior studies have not focused on care for diabetes, a prevalent condition for minority populations.
  
  
  OBJECTIVE
  To examine the association of residential segregation with a range of access and quality of care outcomes among black and Hispanics with diabetes using a nationally representative US sample.
  
  
  METHODS
  Cross-sectional study using data for 1598 adult patients with diabetes from the 2006 Medical Expenditure Panel Survey linked to residential segregation information for blacks and Hispanics on the basis of the 2000 census. Relationships of 5 dimensions of residential segregation (dissimilarity, isolation, clustering, concentration, and centralization) with access and quality of care outcomes were examined using linear, logistic, and multinomial logistic regression models, controlling for respondent characteristics and community utilization and hospital capacity.
  
  
  RESULTS
  Black and Hispanics with diabetes had comparable or better access to providers, but received fewer recommended services. Living in a segregated community was associated with more recommended services received, but also problems with seeing a specialist. The relationship of residential segregation to diabetes care varied depending on type of segregation and race/ethnic group assessed.
  
  
  CONCLUSIONS
  Residential segregation influences the care experience of patients with diabetes in the United States. Our study highlights the importance of investigating how different types of segregation may affect diabetes care received by patients from different race and ethnic groups.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. kchan@jhsph.edu
authors.forename: Kitty S
authors.initials: KS
authors.lastname: Chan
authors.forename: Darrell J
authors.initials: DJ
authors.lastname: Gaskin
authors.forename: Gniesha Y
authors.initials: GY
authors.lastname: Dinwiddie
authors.forename: Rachael
authors.initials: R
authors.lastname: McCleary
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000458:organization & administration; D006630:Hispanic or Latino / 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 / Q000458:organization & administration; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D055815:Young Adult