About Diabetes Disparities
As the American population ages and becomes increasingly diverse, the consequences of inadequate health care to low-income, underserved, uninsured and underinsured groups are becoming progressively serious, particularly for those who have or are at risk for developing diabetes. With nearly 24 million people (about 8 percent of the U.S. population) already diagnosed with diabetes and the costs associated with this disease skyrocketing, it is critical not only to understand how and why disparities exist, but also to invest in prevention and management initiatives that can address the special needs of underserved communities.
Disparities in health care are often a result of environmental conditions, social and economic factors, insufficient health resources and poor disease management. With many causes for these critical gaps in care, success in reducing disparities can only come by addressing these factors together. Type 2 diabetes disproportionately affects people of certain racial and ethnic groups, including African-Americans, American Indians, Asian Americans, Hispanics/Latinos and Pacific Islanders. These groups also make up a disproportionate share of the poor and uninsured. They may live in substandard housing or in low-income neighborhoods with plentiful fast-food restaurants but lacking in grocery stores that carry healthy foods, resulting in higher rates of overweight and obesity. In urban neighborhoods, a lack of sidewalks and crime-free parks also may discourage the daily physical activity needed to maintain a healthy lifestyle. However, even when minority populations do have access to good food and physical activity, many continue to receive a lower quality of care than non-minorities. A 2003 Institute of Medicine report cited stereotyping, biases, language and geographical and cultural barriers as possible explanations.
The consequences of disparate care can be dire. According to the U.S. Department of Health and Human Services' Centers for Disease Control and Prevention, chronic conditions such as diabetes and its numerous complications (including nerve, heart and kidney disease) are the leading cause of death, disability and illness in the United States. But it needn't be so. Research has shown that lifestyle changes (such as being physically active, eating healthy and losing weight) can prevent or delay diabetes. Likewise, proper management of diabetes once diagnosed (e.g., maintaining glucose, cholesterol and blood pressure control) can significantly delay or prevent its numerous complications. Disparities in routine preventive care and treatment among racial and ethnic groups may therefore contribute to the higher prevalence of diabetes and its complications among these populations.