Diabetes Numeracy An overlooked factor in understanding racial disparities in glycemic control
Diabetes Numeracy An overlooked factor in understanding racial disparities in glycemic control
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DOI：
10.2337/dc09-0425
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发表时间：
2009-09-01
期刊：
影响因子：
16.2
通讯作者：
Rothman, Russell L.
中科院分区：
文献类型：
--
作者：
Osborn, Chandra Y.;Cavanaugh, Kerri;Rothman, Russell L.
目的-了解糖尿病的原因并消除普遍存在的健康差异是一个主要的研究，临床和卫生政策目标，我们检查了健康素养，一般算术，和糖尿病相关的算术解释了非裔美国人种族和糖尿病患者血糖控制不良（A1 C）之间的关系。在三个医疗中心的初级保健和糖尿病诊所参加了一项横断面研究。收集的数据包括：自我报告的种族，健康素养，一般计算能力，糖尿病相关的计算能力，A1 C和社会人口因素。一系列的结构方程模型估计，以探讨变量之间的相互关系和中介检验。（r =-0.21，P < 0.001），胰岛素使用（r = 0.27，P < 0.001）、糖尿病患病年限较长（r = 0.16，P < 0.01）和非裔美国人（r = 0.12，P < 0.01）均与血糖控制较差相关。在模型2中，糖尿病相关的计算能力是A1 C的强预测因子（r =-0.46，P < 0.001），将非裔美国人与血糖控制不良之间的关联降低至无显著性（r = 0.10，NS）。在模型3中，非裔美国人的种族和年龄较大的与较低的糖尿病相关的算术;年轻的年龄，胰岛素的使用，更多年的糖尿病，和较低的糖尿病相关的算术与血糖控制不良。结论-糖尿病相关的算术降低了非裔美国人的种族，这样的低糖尿病相关的算术，而不是非洲裔美国人的种族，是显着相关的血糖控制不良。解决算术问题的干预措施可能有助于减少糖尿病的种族差异。
OBJECTIVE - Understanding the reasons and eliminating the pervasive health disparities in diabetes is a major research, clinical, and health policy goal, We examined whether health literacy, general numeracy, and diabetes-related numeracy explain the association between African American race and poor glycemic control (A1C) in patients with diabetes.RESEARCH DESIGN AND METHODS - Adults with type 2 diabetes (n = 383) were enrolled in a cross-sectional study at primary care and diabetes clinics at three medical centers. Data collected included the following: self-reported race, health literacy, general numeracy, diabetes-related numeracy, A1C, and sociodemographic factors. A series of Structural equation models were estimated to explore the interrelations between variables and test for mediation.RESULTS - in model 1, younger age (r = -0.21, P < 0.001), insulin use (r = 0.27, P < 0.001), greater years with diabetes (r = 0.16, P < 0.01), and African American race (r = 0.12, P < 0.01) were all associated with poorer glycemic control. In model 2, diabetes-related numeracy emerged as a strong predictor of A1C (r = -0.46, P < 0.001), reducing the association between African American and poor glycemic control to nonsignificance (r = 0.10, NS). In model 3, African American race and older age were associated with lower diabetes-related numeracy; younger age, insulin use, more years with diabetes, and lower diabetes-related numeracy were associated with poor glycemic control.CONCLUSIONS - Diabetes-related numeracy reduced the explanatory power of African American race, such that low diabetes-related numeracy, not African American race, was significantly related to poor glycemic control. Interventions that address numeracy could help to reduce racial disparities in diabetes.