title: Prevalence of and disparities in barriers to care experienced by youth with type 1 diabetes.
abstract: OBJECTIVE
  To describe the prevalence of access and process barriers to health care and to examine their relationship to sociodemographic and disease factors in a large and diverse cohort of US youth with type 1 diabetes.
  
  
  METHODS
  A cross-sectional analysis of 780 youth who participated in the SEARCH for Diabetes in Youth Study and were diagnosed with type 1 diabetes in 2002-2005. Experience of barriers to care was collected from parent report on questionnaires. Analyses included multivariate regression models to predict the presence of specific barriers to care.
  
  
  RESULTS
  Overall, 81.7% of participants reported at least one barrier; the 3 most common were costs (47.5%), communication (43.0%), and getting needed information (48.4%). Problems with access to care, not having a regular provider, and receiving contextual care (care that takes into account personal and family context) were associated with poorer glycated hemoglobin levels. Adjusted multivariate models indicated that barriers related to access (regular provider, cost) were most likely for youth with low family income and those without public health insurance. Barriers associated with the processes of quality care (contextual care, communication) were more likely for Hispanic youth and those whose parents had less education.
  
  
  CONCLUSIONS
  This study indicates that a large proportion of youth with type 1 diabetes experience substantial barriers to care. Barriers to access and those associated with processes of quality care differed by sociodemographic characteristics. Future investigators should expand knowledge of the systemic processes that lead to disparate outcomes for some youth with diabetes and assess potential solutions.
authors.affiliation: Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL. Electronic address: Jessica.Valenzuela@nova.edu.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Valenzuela
authors.affiliation: Division of Pulmonary Medicine and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Michael
authors.initials: M
authors.lastname: Seid
authors.affiliation: Pacific Health Research Institute, Honolulu, HI; Kaiser Permanente Center for Health Research Hawaii, Honolulu, HI.
authors.forename: Beth
authors.initials: B
authors.lastname: Waitzfelder
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Anderson
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Beavers
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO.
authors.forename: Dana M
authors.initials: DM
authors.lastname: Dabelea
authors.affiliation: Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Dolan
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Imperatore
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Santica
authors.initials: S
authors.lastname: Marcovina
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
authors.forename: Kristi
authors.initials: K
authors.lastname: Reynolds
authors.affiliation: Seattle Children's Hospital, Seattle, WA.
authors.forename: Joyce
authors.initials: J
authors.lastname: Yi-Frazier
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Mayer-Davis
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards / Q000639:trends; D018570:Risk Assessment; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult