title: Insurance, racial/ethnic, SES-related disparities in quality of care among US adults with diabetes.
abstract: Diabetes-related quality improvement initiatives are typically aimed at improving outcomes and reducing complications. Studies have found that disparities in quality persist for certain racial/ethnic and socioeconomically disadvantaged groups; however, results are mixed with regard to insurance-based differences. The purpose of this study is to investigate the independent associations between type of health insurance coverage, race/ethnicity, and socioeconomic status (SES), and quality of care, as measured by benchmark indicators of diabetes-related primary care. This study used the Diabetes Care Survey of the 2010 Medical Expenditure Panel Survey. Bivariate and multivariate logistic regressions were used to examine the association between quality of diabetes care and type of insurance coverage, race/ethnicity, and SES. Multivariate analyses also controlled for additional demographic and health status characteristics. Respondents with insurance coverage (particularly those with private insurance or with Medicare and Medicaid coverage) were more likely to receive quality diabetes care than uninsured individuals. Few significant disparities based on race/ethnicity or SES persisted in subsequent multivariate analyses. Findings suggest that insurance coverage may make the greatest impact in ensuring equitable distribution of quality diabetes care, regardless of race/ethnicity or socioeconomic status. With the implementation of Affordable Care Act under which more people could potentially gain access to insurance, policymakers should next track insurance-based diabetes care disparities.
authors.affiliation: School of Public Health, and Center of Migrant Health Policy, Sun Yat-sen University, Guangzhou, China.
authors.forename: Ruwei
authors.initials: R
authors.lastname: Hu
authors.forename: Leiyu
authors.initials: L
authors.lastname: Shi
authors.forename: Sarika
authors.initials: S
authors.lastname: Rane
authors.forename: Jinsheng
authors.initials: J
authors.lastname: Zhu
authors.forename: Chien-Chou
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology