title: Racial/ethnic differences in healthcare use among patients with uncontrolled and controlled diabetes.
abstract: OBJECTIVE
  To examine racial/ethnic differences in healthcare use among patients classified as having controlled and uncontrolled diabetes.
  
  
  METHODS
  Data from the Carolinas HealthCare System electronic data warehouse were used. Glycemic control was defined as glycosylated hemoglobin (HbA1c) < 8% (64 mmol/mol) in 2012 (n = 9996). Patients with HbA1c ≥ 8% (64 mmol/mol) in 2012 were classified as uncontrolled (n = 2576). Race and ethnicity were jointly classified as non-Hispanic Black, non-Hispanic White or Other. Separate mixed effects negative binomial models estimated the independent effect of race/ethnicity on the number of emergency department (ED) visits, hospitalizations and physician office visits in 2013, in each patient group, adjusting for significant confounding variables.
  
  
  RESULTS
  Rates of diabetes-related ED visits were two to three times higher for non-Hispanic Blacks compared to non-Hispanic Whites (uncontrolled rate ratio [RR]: 3.41 95% CI: 1.41-8.22; controlled RR: 2.95; 95% CI: 1.78-4.91). Similar differences were observed for all-cause ED visits (uncontrolled RR: 1.83, 95% CI: 1.50-2.24; controlled RR: 2.45, 95% CI: 2.17-2.77). Non-Hispanic Blacks with controlled and uncontrolled diabetes also had lower rates of all-cause physician office visits when compared to non-Hispanic Whites (uncontrolled RR: 0.84, 95% CI: 0.77-0.91; controlled RR: 0.81, 95% CI: 0.78-0.84).
  
  
  CONCLUSIONS
  Notable racial/ethnic disparities exist in the use of emergency services and physician offices for diabetes care. Strategies such as patient education and care delivery changes that address healthcare access issues in racial/ethnic minorities should be considered to offer better diabetes management and address diabetes disparities.
authors.affiliation: a Center for Outcomes Research and Evaluation , Carolinas HealthCare System , Charlotte , USA.
authors.forename: Yhenneko J
authors.identifier: 0000-0002-5336-5666
authors.initials: YJ
authors.lastname: Taylor
authors.affiliation: a Center for Outcomes Research and Evaluation , Carolinas HealthCare System , Charlotte , USA.
authors.forename: Melanie D
authors.initials: MD
authors.lastname: Spencer
authors.affiliation: a Center for Outcomes Research and Evaluation , Carolinas HealthCare System , Charlotte , USA.
authors.forename: Rohan
authors.initials: R
authors.lastname: Mahabaleshwarkar
authors.affiliation: b Department of Family Medicine , Carolinas HealthCare System , Charlotte , USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ludden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D003920:Diabetes Mellitus / Q000208:ethnology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D044469:Racial Groups / Q000208:ethnology*; D014481:United States
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: HbA1c; Health care disparities; emergency services; glycemic control; health care utilization; primary care utilization