About Diabetes Disparities
WHAT IS DIABETES?
Diabetes is a group of diseases marked by high levels of blood glucose, also called blood sugar, resulting from defects in insulin production, insulin action or both. Diabetes can lead to serious complications and premature death. By working together, people with diabetes, their support networks, and their health care providers can reduce the occurrence of diabetes complications.1
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. Diabetes affects 25.8 million people (about 8.3 percent of the U.S. population2). As the costs associated with this disease skyrocket, 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. Success in identifying critical gaps in care and reducing disparities can be realized by addressing these factors together. That’s why The Merck Company Foundation launched the Alliance to Reduce Disparities in Diabetes (the Alliance) in 2009 to employ a multi-pronged approach to addressing this critical issue.
Individuals in specific racial and ethnic groups experience the greatest prevalence and widest disparity in outcomes for both type I and type II diabetes.3 Type 2 diabetes disproportionately affects African-Americans, American Indians, Asian Americans, Hispanics/Latinos and Pacific Islanders. These groups also make up a disproportionate share of the poor and uninsured.4
Additionally, living in substandard housing or in low-income neighborhoods results in higher rates of overweight and obesity due to lack of healthy food options and oppurtunities for safe physical activity. However, even when minority populations do have acces to good food and physical activity, many continue to receive a lower quality of care than non-minorities.5
WHO HAS DIABETES?
Of those aged 20 years or older, data adjusted by population age7 finds:
- 7.1 percent of non-Hispanic whites have diabetes
- 8.4 percent of Asian Americans and Pacific Islanders have diabetes
- 11.8 percent of Hispanics have diabetes (12.6 percent of Puerto Ricans have diabetes, 11.9 percent of Mexican Americans have diabetes)
- 12.6 percent of African-Americans have diabetes
- 16.1 percent of American Indians and Alaska Natives have diabetes,8 though rates are higher in some tribes. Native Americans have the highest diabetes prevalence rates in the world
A national report released in 2000 by the U.S. Department of Health and Human Services found that African-Americans, Mexican Americans and American Indians in particular were experiencing a sharp rise in the prevalence of type 2 diabetes.9
WHO PROVIDES COVERAGE FOR THEIR HEALTH CARE?
Of the U.S. population, those with diabetes (both diagnosed and undiagnosed) represent:
- 5.9 percent of those with private insurance
- 13 percent of those with government insurance (including Medicaid and Medicare)
- 5.4 percent of the uninsured10
WHO ARE THE UNINSURED?
Members of racial and ethnic groups likewise make up a disproportionate share of the non-elderly uninsured population.
- 22.8 percent of African-Americans are uninsured
- 35.7 percent of Hispanics are uninsured
- 12.6 percent of non-Hispanic whites are uninsured11
Compared to insured adults, uninsured adults with diabetes are less likely to receive the proper standard of care, including regular glucose monitoring and preventive check-ups for their eyes and feet. This can lead to a greater risk of hospitalization and an increased risk of chronic disease and disability.12
Poverty is a major factor in access to health care. Families earning less than $10,000 per year make up the greatest percentage of the uninsured (35.7 percent), compared to just 7.1 percent of those who earn more than $75,000 per year.13
Poverty rates in the United States are:
- 25.9 percent for American Indians
- 25.8 percent for African-Americans
- 25.3 percent for Hispanics
- 9.4 percent for non-Hispanic whites14
- Centers for Disease Control and Prevention. National Diabetes Factsheet, 2011. Atlanta, GA: U.S. Department of Health and Human Services, 2011. http://www.cdc.gov/diabetes/pubs/pdf/hdfs_2011.pdf
- Centers for Disease Control and Prevention: National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
- Unequal Access: Insurance Instability Among Low-Income Workers and Minorities, Michelle M. Doty and Alyssa L. Holmgren, The Commonwealth Fund, April 2004. http://www.commonwealthfund.org/usr_doc/doty_unequalaccess_ib_729.pdf
- Institute of Medicine of the National Academies. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. 2003. The National Academies Press.
- Chin, MH, Goldmann, D: Meaningful disparities reduction through research and translation programs. JAMA 305:404-405, 2011.
- The American Diabetes Association (ADA) strongly encourages controlling for population age differences when making racial and ethnic comparisons in the prevalence of diabetes, because most minority populations are younger and tend to develop diabetes at earlier ages than the non-Hispanic white population. This is important because the longer you live with diabetes, the more damage it can do to your body.
- See 1.
- Centers for Disease Control and Prevention and the National Institutes of Health, HealthyPeople 2010. Chapter 5. 2000. www.healthypeople.gov/Document/HTML/Volume1/05Diabetes.htm
- “Economic Costs of Diabetes in the U.S. in 2007,” Diabetes Care, 2008; Vol. 31: pp. 1-20.
- Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
- “Coverage Matters for Individuals,” Covering the Uninsured, www.CoverTheUnisured.org.
- “Broken Promises: Evaluating the Native American Health Care System,” U.S. Commission on Civil Rights, September 2004. www.usccr.gov/pubs/nahealth/nabroken.pdf
- Indian Health Service, Division of Diabetes Treatment and Prevention. Diabetes in American Indians and Alaska Natives: Facts At-a-Glance, June 2008. www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=resourcesFactSheets_AIANs08
- Heisler, M. et al. “Racial Disparities in Diabetes Care Processes, Outcome, and Treatment Intensity,” Medical Care, November 2003; Vol. 41, No. 11: pp. 1221-32.
- Presentation by Michelle Gourdine at the American Diabetes Association’s 2008 Annual Partnership Forum. See www.diabetes.org.
- Mainous III, A.G. et al., “Quality of Care for Hispanic Adults with Diabetes,” Family Medicine, 2007; Vol. 39, No. 5: pp. 351-6.