Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study.

TitleMechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study.
Publication TypeJournal Article
Year of Publication2007
AuthorsHeisler, MM, Faul, J, Hayward, RA, Langa, KM, Blaum, CS, Weir, DR
JournalArch Intern Med
Date Published2007 Sep 24
ISSN Number0003-9926
Call Numbernewpubs20071203_HeislerFaul.pdf
KeywordsAged, Aged, 80 and over, Black People, Diabetes Mellitus, Female, Glycated Hemoglobin, Health Services Accessibility, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Patient Compliance, Socioeconomic factors, Treatment Refusal, United States, White People

BACKGROUND: Mechanisms for racial/ethnic disparities in glycemic control are poorly understood.

METHODS: A nationally representative sample of 1901 respondents 55 years or older with diabetes mellitus completed a mailed survey in 2003; 1233 respondents completed valid at-home hemoglobin A(1c) (HbA(1c)) kits. We constructed multivariate regression models with survey weights to examine racial/ethnic differences in HbA(1c) control and to explore the association of HbA(1c) level with sociodemographic and clinical factors, access to and quality of diabetes health care, and self-management behaviors and attitudes.

RESULTS: There were no significant racial/ethnic differences in HbA(1c) levels in respondents not taking antihyperglycemic medications. In 1034 respondents taking medications, the mean HbA(1c) value (expressed as percentage of total hemoglobin) was 8.07% in black respondents and 8.14% in Latino respondents compared with 7.22% in white respondents (P < .001). Black respondents had worse medication adherence than white respondents, and Latino respondents had more diabetes-specific emotional distress (P < .001). Adjusting for hypothesized mechanisms accounted for 14.0% of the higher HbA(1c) levels in black respondents and 19.0% in Latinos, with the full model explaining 22.0% of the variance. Besides black and Latino ethnicity, only insulin use (P < .001), age younger than 65 years (P = .007), longer diabetes duration (P = .004), and lower self-reported medication adherence (P = .04) were independently associated with higher HbA(1c) levels.

CONCLUSIONS: Latino and African American respondents had worse glycemic control than white respondents. Socioeconomic, clinical, health care, and self-management measures explained approximately a fifth of the HbA(1c) differences. One potentially modifiable factor for which there were racial disparities--medication adherence--was among the most significant independent predictors of glycemic control.

User Guide Notes

Endnote Keywords

Racial Differences/Diabetes Mellitus

Endnote ID


Alternate JournalArch Intern Med
Citation Key7168
PubMed ID17893306
Grant ListU01 AG009740 / AG / NIA NIH HHS / United States
K08 AG19180 / AG / NIA NIH HHS / United States
P60DK-20572 / DK / NIDDK NIH HHS / United States
U01AG09740 / AG / NIA NIH HHS / United States