Research That Matters (January 17 - 20, 2008)

Purpose: Twenty-one million people in the United States have diagnosed and undiagnosed diabetes and forty-one million people in the United States that have pre-diabetes (CDC, 2005) can develop diabetes in the future. Though improvements in diabetic care have been made in the last decade, much has yet to be uncovered as to the differential disparities for racial minorities. The increasing prevalence of diabetes in the African American community, especially among women, calls for additional attention to health care quality and accessibility in order to understand which contemporary factors impact early recognition of a diabetic problem. Hence, the study responds to whether a diabetes disparity exists among women of color in California, whether poverty status plays a role in differential rates of treatment seeking, and what factors predict diabetes diagnosis. Methods: This study uses data from the 2005 California Health Interview Survey, a population-based telephone survey of adult residents of California (N = 43,020). The sample population of 25,548 women included, 1,219 African American women, 3,781 Hispanic women, 1,219 Asian American women, and 17,208 White women. Diabetes was measured dichotomously by affirmation of a diabetes diagnosis. Health insurance was measured by self-reported health insurance type. Chi-square analysis and logistic regression models were conducted on full models using the entire CHIS sample of women and separate models for each of the self identified race categories of African American, Asian American, Hispanic and White to answer the research objectives. All logistic regression models controlled for known covariates. Replicate weighting procedures were utilized for all analyses to account for design effects. Results: African American (10%), Hispanic (7%) and American Indian (13%) women recorded the highest diabetes rates. Black women reported one of the highest percentages of diabetes diagnosis and were underrepresented in several private insurance plans. Further, 30% of women below 200% of the federal poverty line (FPL) were diagnosed with diabetes and 34% of African American women diagnosed with diabetes were 300% FPL. Moreover, for Black women logistic regression analysis revealed a significant, positive relationship between age and diabetes. Residential location did not affect an indication of diabetes diagnosis for African American women. Other analysis shows that covariates increasing diabetes diagnosis for all women include age, poverty status, public assistance receipt, utilizing more than one place for healthcare, and health insurance types. Implications: The findings highlight how metropolitan social experiences may result in adverse health for African American and Hispanic women and lead to diabetes problems that might not receive proper medical treatment. Diabetes' higher prevalence among poor African Americans calls for social workers to pay particular attention to intervention strategies that integrate general physical health concerns with medical visits even if health insurance is not owned. Social workers in health settings need to attend to preventative interventions such as weight reduction strategies, promote self-feet sore exams, assist with monitoring tests for diabetes diagnosis, and remain involved in treatment interventions for at-risk women, especially African Americans, at all ages to improved health outcomes overall.