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Author List:
Halanych JH (Birmingham VA)
Miller DR (Bedford VA)
Lin H (Bedford VA)
Wang F (Bedford VA)
Berlowitz DR (Bedford VA)
Pogach LM (East Orange VA)
Frayne SM (Palo Alto VA)
Objectives:
Recent evidence shows a decrease in black-white disparities in care of chronic medical conditions in VHA. Hispanic veterans have not been extensively studied, although data demonstrate “Hispanic” classifications in VHA databases are valid. Using VHA supplemented with Medicare data, we examined diabetes care in Hispanic, black, and white veterans.
Methods:
In non-institutionalized, VHA patients with diabetes (based on ICD9 codes and antiglycemic prescriptions) nationally, we compared established diabetes quality measures for FY1999 (from VHA and Medicare administrative files and VHA lab files) in Hispanic, black, and white veterans. We performed unadjusted logistic regression for process measures (HbA1c testing, LDL testing, and eye exam), and unadjusted, casemix-adjusted (age, gender, education, income, and comorbidity) and casemix-and-facility-adjusted logistic regression for intermediate outcome measures (HbA1c >= 9.5 and LDL >= 130). In sensitivity analyses we restricted the cohort to those >= 65 years old (presumable Medicare-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 to whites), respectively, odds ratios (95% C.I.) for bivariate comparisons of process measures 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 outcome odds 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 and accounting for casemix and facility did not alter the results.
Implications:
Both Hispanics and blacks were less likely to receive HbA1c, LDL, and eye exams 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 relatively under-studied. Because VHA is committed to reducing all racial disparities, Hispanics should also be targeted in interventions to improve diabetes care. Additionally, factors contributing to racial/ethnic disparities need to be identified and addressed.
