Limited Health Care Access Impairs Glycemic Control in Low Income 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.

Depressive symptomatology mediates the effect of socioeconomic disadvantage on HbA1c among rural African Americans with type 2 diabetes

“…Cubbin [13] found that living in a neighborhood with high material deprivation predicted smoking, physical inactivity, and obesity. Other studies suggest that poverty affects diabetes complications via barriers to medical care in low-income neighborhoods [30]. Crime, which is also more prevalent in disorganized, lowsocioeconomic status (SES) neighborhoods than in more affluent communities, is linked to poor adherence to asthma regimens among African Americans [31] and impedes physical activity [32].…”

Disparities in HbA1c Levels Between African-American and Non-Hispanic White Adults With Diabetes

“…A number of factors may drive differences in A1C control: biological, socioeconomic, and quality-of-care factors have been suggested (9,12). Lack of access to health care may also affect diabetes care among minority individuals (13). African Americans report lower rates of health insurance than non-Hispanic whites.…”

Health Insurance and Diabetes Among Multiracial Men: The Mediation Effects of Usual Source of Care

“…In sum, the research suggests that having a regular source of care can lead to better diabetes management and overall health outcomes (Mainous et al, 2004). Further, fewer African American, Latino, and Asian American men use private doctors as their usual source of care than whites when suffering from health conditions (Gaskin et al, 2007;Rhee et al, 2005). The present study fills the gap in literature by directly testing how having a usual source of care may vary drastically for insured and uninsured men.…”