Young BA (Seattle ERIC, Seattle HSR&D), Rees C
(University of Washington), Frank D
Racial and ethnic differences exist in the prevalence and incidence of diabetes and diabetes complications. Few studies have evaluated self-reported feelings of discrimination and associations with diabetes and long-term diabetes outcomes. We sought to determine racial and ethnic differences in global reporting of experiences of discrimination and associations with diabetes characteristics.
The VA Pathways study is a prospective cohort study designed to evaluate self-reported diabetes characteristics, quality of life, and self-reported discrimination among veterans with diabetes in the Pacific Northwest. A total of 7668 veterans in the Seattle/Tacoma Washington area were identified from administrative databases with diabetes either by ICD-9 code or by prescription of diabetic medications. Demographics were compared using student t-tests and chi-squared tests. Logistic regression models were used to determine association of hemoglobin A1c and reports of discrimination.
Of the 1880 surveys received, 1706 were available for analysis. Of the respondents, 75.6% were white, 9.50% African American, 2.05% Asian, 1.60% Native American, 4.34% Hispanic, and 4.22% were other race/ethnicity. Less than a quarter (24%) had an education of high school or less, 63.3% were married, 66.2% had income less than $20,000, only 14.8% were employed full-time, and 19.4% reported being retired. Diabetes duration was greater than five years or more for 66% of the population, while 14.5% of veterans started insulin within a few month of their diagnosis of diabetes. Poor to very poor health was reported by 15% of respondents, while 81.4% reported being satisfied with their diabetes care. Fourteen percent of all veterans reported being treated unfairly due to race, sex, language, veteran status, diabetes, or other reasons. Of those veterans, 64.5% were white, 17.7% were African American, 1.3% Asian, 3.5% Native American, and 14.4% Hispanic. When asked if they would try to do something about it, 65.8% of veterans reported they would, while 66.9% reported they would talk to others about it. Compared to whites, minority veterans were 5-24 times (depending on the group) more likely to report prior experiences with discrimination after adjustment for age, duration of diabetes, sex, education, and insulin use. Those who reported experiences with discrimination were 47% (Odds Ratio = 1.47, 95% CI 1.02-2.12) more likely to have a hemoglobin A1c > 8.0% after adjustment for age, sex, income, duration of diabetes, education, race, BMI, and service connection.
These preliminary results show that many minority veterans experience significant discrimination in many aspects of their lives compared to whites. All veterans who experience discrimination are 47% more likely to have poor diabetes control regardless of race. Further research will evaluate whether these feelings are associated with additional diabetes characteristics, tobacco and alcohol use, and long-term outcomes.
Compared to white veterans, minority veterans are more likely to have experienced discrimination in their lives. Those who experience discrimination are more likely to have poor glucose control compared to those who do not experience discrimination.