Reducing disparities in diabetes through expanded insurance coverage.

描述（由申请人提供）：2型糖尿病在美国种族和少数民族中造成不成比例的健康负担。与此同时，这些少数民族人口是最有可能没有保险或经历医疗保险中断的人群。缺乏保险与患未确诊糖尿病的可能性增加有关，并且与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，医疗改革走向实施，在扩大保险覆盖范围对人口健康的预期影响，特别是对健康差异可能产生的影响的理解方面仍然存在重大差距。特别是对于糖尿病，迫切需要一个全面的分析，追踪从保险到降低发病率和死亡率的整个途径，并为以前的观察性和准实验性研究提供一个统一的框架。本研究的总体目标是采用系统和严格的实证分析，在国家和州一级调查扩大保险覆盖范围对糖尿病健康差异的潜在影响。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，量化扩大糖尿病患者保险覆盖范围的潜在影响，并按种族和族裔群体划分。2)基于反映不同保险覆盖情景的替代人口风险因素分布，预测由于保险覆盖范围扩大而导致的糖尿病相关发病率和死亡率的种族/民族差异的减少。3)通过比较2006年具有里程碑意义的医疗改革扩大保险覆盖面后马萨诸塞州的预测结果和观察结果，评估模型结果的有效性。总的来说，拟议的研究活动将构成一个连贯的、重要的和创新的进展，以解决与糖尿病差异相关的政策信息的关键差距，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制定缩小健康差距的现实目标，以及随着国家卫生保健政策的重大发展，为评价实现这些目标的进展确定关键基准至关重要。

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.