title: Racial and Economic Disparities in Diabetes in a Large Primary Care Patient Population.
abstract: OBJECTIVE
  We sought to determine if, after adjusting for economic status, race is an independent risk factor for glycemic control among diabetic patients in a large primary care patient population.
  
  
  METHODS
  We performed a retrospective chart review of 264,000 primary care patients at our large, urban academic medical center to identify patients with a diagnosis of diabetes (n=25,123). Zip code was used to derive median income levels using US Census Bureau demographic information. Self-reported race was extracted from registration data.
  
  
  METHODS
  The prevalence of diabetes, average glycated hemoglobin (A1c), and prevalence of uncontrolled diabetes of White and Black patients at all income levels were determined.
  
  
  RESULTS
  White patients had a lower average A1c level and a lower prevalence of diabetes than Black patients in all income quartiles (P<.001). Among White patients, the prevalence of diabetes (P<.001), uncontrolled diabetes (P<.001), and A1c level (P=.014) were inversely proportional to income level. No significant difference in the prevalence of diabetes (P=.214), A1c level (P=.282), or uncontrolled diabetes related to income was seen in Black patients (P=.094).
  
  
  CONCLUSIONS
  Race had an independent association with diabetes prevalence and glycemic control. Our study does not support two prominent theories that economic and insurance status are the main factors in diabetes disparities, as we attempted to control for economic status and nearly every patient had insurance. It will be important for future analysis to explore how health care system factors affect these observed gaps in quality.
authors: Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.
authors: Danielle L
authors: DL
authors: Heidemann
authors: Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.
authors: Nicholas A
authors: NA
authors: Joseph
authors: Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.
authors: Aishwarya
authors: A
authors: Kuchipudi
authors: Department of Family Medicine, Henry Ford Hospital, Detroit, MI.
authors: Denise White
authors: DW
authors: Perkins
authors: Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.
authors: Sean
authors: S
authors: Drake
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001786:Blood Glucose; D003920:Diabetes Mellitus / Q000191:economics / Q000208:ethnology*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007182:Income; D011320:Primary Health Care / Q000706:statistics & numerical data*; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes Complications; Diabetes Mellitus; Health Care Disparities; Racial Disparities; Socioeconomic Factors