Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study
Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study
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DOI：
10.1001/archinte.167.17.1853
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发表时间：
2007-09-24
影响因子：
--
通讯作者：
Weir, David
中科院分区：
文献类型：
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作者：
Heisler, Michele;Faul, Jessica D.;Weir, David
背景资料：在血糖控制的种族/民族差异机制知之甚少。方法：一个全国代表性的样本1901受访者55岁或以上的糖尿病患者完成了邮寄调查，在2003年，1233受访者完成了有效的在家里血红蛋白A（1C）（HbA（1C））试剂盒。我们构建了多变量回归模型与调查权重，以检查种族/民族的差异，HbA（1c）控制和探讨HbA（1c）水平与社会人口和临床因素，获得和质量的糖尿病保健，自我管理的行为和attitudes.Results的关联：有没有显着的种族/民族差异，HbA（1c）水平的受访者不服用抗高血糖药物。在1034名服用药物的受访者中，平均HbA（1c）值（表示为总血红蛋白的百分比）在黑人受访者中为8.07%，在拉丁美洲受访者中为8.14%，而在白色受访者中为7.22%（P <0.05）。001）。黑人受访者的药物依从性比白色受访者差，拉丁裔受访者有更多的糖尿病特有的情绪困扰（P <. 001）。调整假设的机制占黑人受访者HbA（1c）水平较高的14.0%，拉丁美洲人为19.0%，完整模型解释了22.0%的方差。除了黑人和拉丁裔，只有胰岛素使用（P <. 001），年龄小于65岁（P =.糖尿病病程延长（P =. 007）。004），和较低的自我报告的药物依从性（P =. 04)与较高的HbA（1c）水平独立相关。结论：拉丁裔和非洲裔美国人的血糖控制比白色受访者差。社会经济学、临床、医疗保健和自我管理措施解释了大约五分之一的HbA（1c）差异。一个潜在的可改变的因素，其中有种族差异-药物依从性-是血糖控制的最重要的独立预测因素之一。
Background: Mechanisms for racial/ethnic disparities in glycemic control are poorly understood.Methods: A nationally representative sample of 1901 respondents 55 years or older with diabetes mellitus completed a mailed survey in 2003; 1233 respondents completed valid at-home hemoglobin A(1c) (HbA(1c)) kits. We constructed multivariate regression models with survey weights to examine racial/ethnic differences in HbA(1c) control and to explore the association of HbA(1c) level with sociodemographic and clinical factors, access to and quality of diabetes health care, and self-management behaviors and attitudes.Results: There were no significant racial/ethnic differences in HbA(1c) levels in respondents not taking antihy-perglycemic medications. In 1034 respondents taking medications, the mean HbA(1c) value (expressed as percentage of total hemoglobin) was 8.07% in black respondents and 8.14% in Latino respondents compared with 7.22% in white respondents (P < . 001). Black respondents had worse medication adherence than white respondents, and Latino respondents had more diabetes-specific emotional distress (P < . 001). Adjusting for hypothesized mechanisms accounted for 14.0% of the higher HbA(1c) levels in black respondents and 19.0% in Latinos, with the full model explaining 22.0% of the variance. Besides black and Latino ethnicity, only insulin use (P < . 001), age younger than 65 years (P = . 007), longer diabetes duration (P = . 004), and lower self-reported medication adherence (P = . 04) were independently associated with higher HbA(1c) levels.Conclusions: Latino and African American respondents had worse glycemic control than white respondents. Socioeconomic, clinical, health care, and self-management measures explained approximately a fifth of the HbA(1c) differences. One potentially modifiable factor for which there were racial disparities-medication adherence-was among the most significant independent predictors of glycemic control.