Limited health care access impairs glycemic control in low socioeconomic status urban African Americans with type 2 diabetes

Mary K. Rhee, Curtiss B. Cook, Virginia G. Dunbar, Rita M. Panayioto, Kathy J. Berkowitz, Barbara Boyd, Christopher D. George, Robert H. Lyles, Imad M. El-Kebbi, Lawrence S. Phillips

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Limited access to health care is associated with adverse outcomes, but few studies have examined its effect on glycemic control in minority populations. Our observational cross-sectional study examined whether differences in health care access affected hemoglobin A1c (HbA1c) levels in 605 patients with diabetes (56% women; 89% African American; average age, 50 years; 95% with type 2 diabetes) initially treated at a municipal diabetes clinic. Patients who had difficulty obtaining care had higher A1c levels (9.4% vs. 8.7%; p=0.001), as did patients who used acute care facilities (9.5%; p<0.001) or who had no usual source of care (10.3%; p<0.001) compared with those who sought care at doctors' offices or clinics (8.6%). In adjusted analyses, HbA1c was higher in persons who gave a history of trouble obtaining medical care (0.57%; p=0.04), among persons who primarily used an acute care facility to receive their health care (0.49%; p=0.047), and in patients who reported not having a usual source of care (1.08%; p=0.009). Policy decisions for improving diabetes outcomes should target barriers to health care access and focus on developing programs to help high-risk populations maintain a regular place of health care.

Original languageEnglish (US)
Pages (from-to)734-746
Number of pages13
JournalJournal of Health Care for the Poor and Underserved
Volume16
Issue number4
StatePublished - Nov 2005

Fingerprint

Social Class
African Americans
Type 2 Diabetes Mellitus
chronic illness
social status
health care
Delivery of Health Care
Health Services Accessibility
Hemoglobins
Population
human being
Cross-Sectional Studies
Outcome Assessment (Health Care)
cross-sectional study
medical care
American
minority
history

Keywords

  • African Americans
  • Diabetes mellitus, type 2
  • Glycemic control
  • Health services accessibility
  • Socioeconomic factors

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy
  • Social Sciences (miscellaneous)

Cite this

Rhee, M. K., Cook, C. B., Dunbar, V. G., Panayioto, R. M., Berkowitz, K. J., Boyd, B., ... Phillips, L. S. (2005). Limited health care access impairs glycemic control in low socioeconomic status urban African Americans with type 2 diabetes. Journal of Health Care for the Poor and Underserved, 16(4), 734-746.

Limited health care access impairs glycemic control in low socioeconomic status urban African Americans with type 2 diabetes. / Rhee, Mary K.; Cook, Curtiss B.; Dunbar, Virginia G.; Panayioto, Rita M.; Berkowitz, Kathy J.; Boyd, Barbara; George, Christopher D.; Lyles, Robert H.; El-Kebbi, Imad M.; Phillips, Lawrence S.

In: Journal of Health Care for the Poor and Underserved, Vol. 16, No. 4, 11.2005, p. 734-746.

Research output: Contribution to journalArticle

Rhee, MK, Cook, CB, Dunbar, VG, Panayioto, RM, Berkowitz, KJ, Boyd, B, George, CD, Lyles, RH, El-Kebbi, IM & Phillips, LS 2005, 'Limited health care access impairs glycemic control in low socioeconomic status urban African Americans with type 2 diabetes', Journal of Health Care for the Poor and Underserved, vol. 16, no. 4, pp. 734-746.
Rhee, Mary K. ; Cook, Curtiss B. ; Dunbar, Virginia G. ; Panayioto, Rita M. ; Berkowitz, Kathy J. ; Boyd, Barbara ; George, Christopher D. ; Lyles, Robert H. ; El-Kebbi, Imad M. ; Phillips, Lawrence S. / Limited health care access impairs glycemic control in low socioeconomic status urban African Americans with type 2 diabetes. In: Journal of Health Care for the Poor and Underserved. 2005 ; Vol. 16, No. 4. pp. 734-746.
@article{b88463319fe44778a5e20429e62f82ff,
title = "Limited health care access impairs glycemic control in low socioeconomic status urban African Americans with type 2 diabetes",
abstract = "Limited access to health care is associated with adverse outcomes, but few studies have examined its effect on glycemic control in minority populations. Our observational cross-sectional study examined whether differences in health care access affected hemoglobin A1c (HbA1c) levels in 605 patients with diabetes (56{\%} women; 89{\%} African American; average age, 50 years; 95{\%} with type 2 diabetes) initially treated at a municipal diabetes clinic. Patients who had difficulty obtaining care had higher A1c levels (9.4{\%} vs. 8.7{\%}; p=0.001), as did patients who used acute care facilities (9.5{\%}; p<0.001) or who had no usual source of care (10.3{\%}; p<0.001) compared with those who sought care at doctors' offices or clinics (8.6{\%}). In adjusted analyses, HbA1c was higher in persons who gave a history of trouble obtaining medical care (0.57{\%}; p=0.04), among persons who primarily used an acute care facility to receive their health care (0.49{\%}; p=0.047), and in patients who reported not having a usual source of care (1.08{\%}; p=0.009). Policy decisions for improving diabetes outcomes should target barriers to health care access and focus on developing programs to help high-risk populations maintain a regular place of health care.",
keywords = "African Americans, Diabetes mellitus, type 2, Glycemic control, Health services accessibility, Socioeconomic factors",
author = "Rhee, {Mary K.} and Cook, {Curtiss B.} and Dunbar, {Virginia G.} and Panayioto, {Rita M.} and Berkowitz, {Kathy J.} and Barbara Boyd and George, {Christopher D.} and Lyles, {Robert H.} and El-Kebbi, {Imad M.} and Phillips, {Lawrence S.}",
year = "2005",
month = "11",
language = "English (US)",
volume = "16",
pages = "734--746",
journal = "Journal of Health Care for the Poor and Underserved",
issn = "1049-2089",
publisher = "Johns Hopkins University Press",
number = "4",

}

TY - JOUR

T1 - Limited health care access impairs glycemic control in low socioeconomic status urban African Americans with type 2 diabetes

AU - Rhee, Mary K.

AU - Cook, Curtiss B.

AU - Dunbar, Virginia G.

AU - Panayioto, Rita M.

AU - Berkowitz, Kathy J.

AU - Boyd, Barbara

AU - George, Christopher D.

AU - Lyles, Robert H.

AU - El-Kebbi, Imad M.

AU - Phillips, Lawrence S.

PY - 2005/11

Y1 - 2005/11

N2 - Limited access to health care is associated with adverse outcomes, but few studies have examined its effect on glycemic control in minority populations. Our observational cross-sectional study examined whether differences in health care access affected hemoglobin A1c (HbA1c) levels in 605 patients with diabetes (56% women; 89% African American; average age, 50 years; 95% with type 2 diabetes) initially treated at a municipal diabetes clinic. Patients who had difficulty obtaining care had higher A1c levels (9.4% vs. 8.7%; p=0.001), as did patients who used acute care facilities (9.5%; p<0.001) or who had no usual source of care (10.3%; p<0.001) compared with those who sought care at doctors' offices or clinics (8.6%). In adjusted analyses, HbA1c was higher in persons who gave a history of trouble obtaining medical care (0.57%; p=0.04), among persons who primarily used an acute care facility to receive their health care (0.49%; p=0.047), and in patients who reported not having a usual source of care (1.08%; p=0.009). Policy decisions for improving diabetes outcomes should target barriers to health care access and focus on developing programs to help high-risk populations maintain a regular place of health care.

AB - Limited access to health care is associated with adverse outcomes, but few studies have examined its effect on glycemic control in minority populations. Our observational cross-sectional study examined whether differences in health care access affected hemoglobin A1c (HbA1c) levels in 605 patients with diabetes (56% women; 89% African American; average age, 50 years; 95% with type 2 diabetes) initially treated at a municipal diabetes clinic. Patients who had difficulty obtaining care had higher A1c levels (9.4% vs. 8.7%; p=0.001), as did patients who used acute care facilities (9.5%; p<0.001) or who had no usual source of care (10.3%; p<0.001) compared with those who sought care at doctors' offices or clinics (8.6%). In adjusted analyses, HbA1c was higher in persons who gave a history of trouble obtaining medical care (0.57%; p=0.04), among persons who primarily used an acute care facility to receive their health care (0.49%; p=0.047), and in patients who reported not having a usual source of care (1.08%; p=0.009). Policy decisions for improving diabetes outcomes should target barriers to health care access and focus on developing programs to help high-risk populations maintain a regular place of health care.

KW - African Americans

KW - Diabetes mellitus, type 2

KW - Glycemic control

KW - Health services accessibility

KW - Socioeconomic factors

UR - http://www.scopus.com/inward/record.url?scp=29244479176&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=29244479176&partnerID=8YFLogxK

M3 - Article

C2 - 16311495

AN - SCOPUS:29244479176

VL - 16

SP - 734

EP - 746

JO - Journal of Health Care for the Poor and Underserved

JF - Journal of Health Care for the Poor and Underserved

SN - 1049-2089

IS - 4

ER -