Disparities in diabetes care in Hispanic, black, and white veterans who use VHA services

Halanych J, Miller D, Lin H, Wang F, Berlowitz D, Pogach L, Frayne S. Disparities in diabetes care in Hispanic, black, and white veterans who use VHA services. Paper presented at: VA HSR&D National Meeting; 2005 Feb 1; Baltimore, MD.

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Objectives: Recent evidence shows a decrease in black-white disparities in care ofchronic medical conditions in VHA. Hispanic veterans have not been extensively studied,although data demonstrate 'Hispanic' classifications in VHA databases are valid. UsingVHA supplemented with Medicare data, we examined diabetes care in Hispanic, black, andwhite veterans.Methods: In non-institutionalized, VHA patients with diabetes (based on ICD9 codes andantiglycemic prescriptions) nationally, we compared established diabetes quality measuresfor FY1999 (from VHA and Medicare administrative files and VHA lab files) in Hispanic,black, and white veterans. We performed unadjusted logistic regression for processmeasures (HbA1c testing, LDL testing, and eye exam), and unadjusted, casemix-adjusted(age, gender, education, income, and comorbidity) and casemix-and-facility-adjustedlogistic regression for intermediate outcome measures (HbA1c > = 9.5 and LDL > = 130).In sensitivity analyses we restricted the cohort to those > = 65 years old (presumableMedicare-eligible).Results: Of 297,289 subjects, 4.3% were Hispanic, 17.3% black, and 78.3% white.Mean age was 66 years and 2% were female. In Hispanics and blacks (compared towhites), respectively, odds ratios (95% C.I.) for bivariate comparisons of processmeasures were 1.33 (1.27, 1.39) and 1.26 (1.23, 1.29) for not receiving HbA1c testing;1.20 (1.15, 1.25) and 1.48 (1.45, 1.51) for not receiving LDL testing; and 1.22 (1.18,1.26) and 1.14 (1.12, 1.16) for not receiving an eye exam. The intermediate outcomeodds ratios were 1.28 (1.23, 1.34) and 1.47 (1.44, 1.50) for HbA1c > = 9.5 and 1.05(1.01, 1.09) and 1.47 (1.44, 1.50) for LDL > = 130. Restricting to age > = 65 andaccounting for casemix and facility did not alter the results.Implications: Both Hispanics and blacks were less likely to receive HbA1c, LDL, and eyeexams and more likely to have poorly controlled glycemia and lipemia than whites.Impacts: Hispanics, now the largest minority group in the U.S., have been relativelyunder-studied. Because VHA is committed to reducing all racial disparities, Hispanics shouldalso be targeted in interventions to improve diabetes care. Additionally, factorscontributing to racial/ethnic disparities need to be identified and addressed.