title: Differential effect of race, education, gender, and language discrimination on glycemic control in adults with type 2 diabetes.
abstract: BACKGROUND
  Discrimination has been linked to negative health outcomes, but little research has investigated different types of discrimination to determine if some have a greater impact on outcomes. We examined the differential effect of discrimination based on race, level of education, gender, and language on glycemic control in adults with type 2 diabetes.
  
  
  METHODS
  Six hundred two patients with type 2 diabetes from two adult primary care clinics in the southeastern United States completed validated questionnaires. Questions included perceived discrimination because of race/ethnicity, level of education, sex/gender, or language. A multiple linear regression model assessed the differential effect of each type of perceived discrimination on glycemic control while adjusting for relevant covariates, including race, site, gender, marital status, duration of diabetes, number of years in school, number of hours worked per week, income, and health status.
  
  
  RESULTS
  The mean age was 61.5 years, and the mean duration of diabetes was 12.3 years. Of the sample, 61.6% were men, and 64.9% were non-Hispanic black. In adjusted models, education discrimination remained significantly associated with glycemic control (β=0.47; 95% confidence interval, 0.03, 0.92). Race, gender and language discrimination were not significantly associated with poor glycemic control in either unadjusted or adjusted analyses.
  
  
  CONCLUSIONS
  Discrimination based on education was found to be significantly associated with poor glycemic control. The findings suggest that education discrimination may be an important social determinant to consider when providing care to patients with type 2 diabetes and should be assessed separate from other types of discrimination, such as that based on race.
authors.affiliation: 1 Center for Health Disparities Research, Medical University of South Carolina , Charleston, South Carolina.
authors.forename: D Brice
authors.initials: DB
authors.lastname: Reynolds
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: Walker
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Campbell
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D001741:Black or African American; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000208:ethnology / Q000523:psychology*; D004522:Educational Status; D004651:Employment; D005260:Female; D006304:Health Status; D006801:Humans; D007802:Language; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D063505:Racism; D012737:Sex Factors; D063507:Sexism; D063508:Social Discrimination / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D015144:Southeastern United States; D044465:White People
chemical_list: D001786:Blood Glucose