title: Diabetes and age-related demographic differences in risk factor control.
abstract: Disparate vascular outcomes in diabetes by race and/or ethnicity may reflect differential risk factor control, especially pre-Medicare. Assess concurrent target attainment for glycohemoglobin <7%, non-high density lipoprotein-cholesterol <130 mg/dL, and blood pressure <140/<90 mm Hg in white, black, and Hispanic diabetics <65 years and ≥65 years of age. The National Health and Nutrition Examination Surveys 1999-2010 data were analyzed on diagnosed and undiagnosed diabetics ≥18 years old. Concurrent target attainment was higher in whites (18.7%) than blacks (13.4% [P = .02] and Hispanics [10.3%, P < .001] <65 years but not ≥65 years of age; 20.0% vs. 15.9% [P = .13], 19.5% [P = .88]). Disparities in health care insurance among younger whites, blacks, and Hispanics, respectively, (87.4% vs. 81.1%, P < .01; 68.0%, P < .001) and infrequent health care (0-1 visits/y; 14.3% vs. 15.0%, P = not significant; 32.0%, P < .001) declined with age. Cholesterol treatment predicted concurrent control in both age groups (multivariable odds ratio >2, P < .001). Risk factor awareness and treatment were lower in Hispanics than whites. When treated, diabetes and hypertension control were greater in whites than blacks or Hispanics. Concurrent risk factor control is low in all diabetics and could improve with greater statin use. Insuring younger adults, especially Hispanic, could raise risk factor awareness and treatment. Improving treatment effectiveness in younger black and Hispanic diabetics could promote equitable risk factor control.
authors: Care Coordination Institute, Greenville Health System, Greenville, SC, USA; Department of Medicine, University of South Carolina School of Medicine, Greenville Health System, Greenville, SC, USA; Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: began@carecoordinationinstitute.org.
authors: Brent M
authors: BM
authors: Egan
authors: Department of Mathematics, College of Charleston, Charleston, SC, USA.
authors: Jiexiang
authors: J
authors: Li
authors: Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors: Tamara E
authors: TE
authors: Wolfman
authors: Care Coordination Institute, Greenville Health System, Greenville, SC, USA; Department of Medicine, University of South Carolina School of Medicine, Greenville Health System, Greenville, SC, USA.
authors: Angelo
authors: A
authors: Sinopoli
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D003920:Diabetes Mellitus / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000379:methods*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Diabetes mellitus; health disparities; hypercholesterolemia; hypertension