Having health insurance does not mitigate the impact of racial and ethnic disparities on glycemic control among adults in the United States, according to a study in JAMA Network Open.
The investigators analyzed data from the National Health and Nutrition Examination Survey. The study population comprised 4,070 adults in the United States between the ages of 25 and 80 years. Patients had self-reported diabetes and health insurance. The mean age was 61.4 years, and 49.3% were women. Thirteen percent were Hispanic or Latino, and 15.7% were non-Hispanic Black.
Hispanic or Latino and Black individuals were less likely than White individuals to have at least a high school education and be food secure. Most Hispanic or Latino participants were born outside of the United States. Private insurance was the most common insurance type overall; however, a higher proportion of Hispanic or Latino and Black individuals had Medicare or Medicaid compared with White individuals. The authors noted that most participants, regardless of race or ethnicity, had a routine location to access health care, though this number was lower for Hispanic or Latino individuals than White individuals.
When adjusted for factors such as age, sex, and survey year, Hispanic or Latino and Black adults had significantly greater odds of having poor glycemic control than non-Hispanic White individuals. The odds ratio (OR) for poor glycemic control was 1.46 for Hispanic or Latino adults (95% CI, 1.16–1.83) and 1.28 for Black adults (95% CI, 1.04–1.57).
Some social factors attenuated the relationship between race/ethnicity and glycemic control. For example, when adjusting for food security, the ORs for poor glycemic control were 1.39 for Latino or Hispanic and Black adults (95% CI, 1.08–1.81). Factors such as health care and behavioral or health status factors increased disparities, particularly for Hispanic and Latino individuals (OR, 1.63; 95% CI, 1.24–2.16). Racial and ethnic disparities persisted among Hispanic and Latino individuals with private insurance, with an OR of 1.66 (95% CI, 1.10–2.52).
“Accounting for health care–related factors resulted in a widening of racial and ethnic disparities, especially for Hispanic or Latino individuals, and this was largely driven by adjustment for use of diabetes medications,” the authors noted. “The disparity was especially large among individuals not using medication, and also among those using both insulin and oral hypoglycemic agents.”
The authors concluded by calling for future studies to evaluate the role of structural barriers that contribute to the high burden of poor glycemic control among insured Hispanic or Latino and Black Americans.