Reducing disparities in diabetes through expanded insurance coverage.

描述(申请人提供)：2型糖尿病在美国的种族和少数民族中造成不成比例的健康负担。与此同时，这些少数群体是最有可能没有保险或经历医疗保险中断的人群之一。缺乏保险与患未确诊糖尿病的可能性更大，以及对确诊糖尿病患者的护理质量较差有关。随着国家立法的通过，医疗改革逐步走向实施，在理解扩大保险覆盖范围对人口健康的预期影响方面，尤其是对健康差距可能产生的影响方面，仍然存在重大差距。尤其是在糖尿病方面，迫切需要一项全面的分析，追踪从保险到降低发病率和死亡率的整个过程，并为以前的观察性和准实验性研究提供一个统一的框架。这项拟议研究的总体目标是部署系统和严格的实证分析，以调查扩大保险覆盖范围对国家和州一级糖尿病健康差距的潜在影响。该项目有三个具体目标：1)根据与糖尿病主要并发症相关的关键可改变风险因素(如高血糖)的改善情况，按种族和民族量化扩大糖尿病患者保险范围的潜在影响。2)根据反映不同保险范围情景的替代人口风险因素分布，预测由于扩大保险范围，糖尿病相关发病率和死亡率方面的种族/族裔差异的减少。3)通过比较马萨诸塞州在2006年具有里程碑意义的医疗改革扩大保险覆盖范围后的预测和观测结果，评估模型结果的有效性。总体而言，拟议的研究活动将是一个连贯的、重大的和创新的进展，旨在解决与糖尿病差距有关的政策信息方面的严重差距，这些差距可以通过医疗保健系统的变化来改善。这些信息对于确定关键优先事项和设定缩小健康差距的现实目标至关重要，对于随着国家卫生保健政策的重大发展而评估实现这些目标的进展情况确定关键基准也是至关重要的。

DESCRIPTION (provided by applicant): type 2 diabetes causes a disproportionate health burden among racial and ethnic minorities in the United States. At the same time, these minority populations are among those most likely to be uninsured or to experience interruptions in healthcare coverage. Lack of insurance is associated with a greater probability of having undiagnosed diabetes, and with poorer quality of care for patients with diagnosed diabetes. As healthcare reform moves toward implementation following the passage of national legislation, important gaps remain in the understanding of the expected population health effects of expanding insurance coverage, and especially regarding the likely impact on health disparities. With respect to diabetes in particular, there is urgent need for a comprehensive analysis that traces the entire pathway from insurance to reduced morbidity and mortality, and provides a unifying framework for previous observational and quasi- experimental studies. The overall goal of this proposed study is to deploy systematic and rigorous empirical analysis to investigate the potential impact of expanding insurance coverage on health disparities in diabetes, at the national and state level. The project has three specific aims: 1) Quantify the potential impact of expanding insurance coverage among diabetic patients, in terms of improvements in key modifiable risk factors (e.g. high blood glucose) associated with major complications of diabetes, by racial and ethnic group. 2) Predict, based on alternative population risk factor distributions reflecting different insurance coverage scenarios, reductions in racial/ethnic disparities in diabetes-related morbidity and mortality attributable to expanded insurance coverage. 3) Evaluate the validity of the model results by comparing predicted and observed outcomes in Massachusetts following the expansion of insurance coverage through the landmark 2006 health reform. Collectively, the proposed research activities will constitute a coherent, significant and innovative advance in addressing critical gaps in policy-relevant information on diabetes disparities that are amenable to improvements through changes in the healthcare system. This information is essential for identifying key priorities and setting realistic targets for reducing health disparities, and for defining critical benchmarks for evaluating progress towards these objectives as major developments in national healthcare policy evolve.