Racial/ethnic Disparity in the Delay of Care and Treatment for Diabetics in California

Purpose: To determine the racial/ethnic disparity in the delay of health care, receiving treatment plan and prescription medication among adults with diabetes in California.

 Background: Hispanics are at high risk for type 2 diabetes. Projections indicate that by 2050, Hispanics will make up 30% of the U.S. population. The age-adjusted prevalence of type 2 diabetes mellitus in Hispanic Americans is twice that in non-Hispanic white Americans. Currently, 10.4% of Hispanics in the U.S. are diagnosed as having diabetes mellitus. Physicians may be hesitant to start insulin because of a belief about patient risk, including risks in people with comorbidities, excess weight gain, hypoglycemia, impaired quality of life, beliefs about patient competence, and resource issues. Patient factors, in delays include fear of hypoglycemia or weight gain, and lack of finances to pay for medication and supplies.

 Methods: We analyzed data from the 2011-2012 California Health Interview Survey (CHIS). The survey is a cross-sectional survey telephone interview of adult population. Diabetes status and race/ethnicity were self-reported. Information related to diabetes care and delay in service and medication were collected by questionnaire. We analyzed the data using the survey module in STATA 11 taking into consideration the sample design and the sample weight.

 Results: of the 4,701 diabetic participants, 8% were African American (AA), 41% Hispanics, and 12% were Asian/Pacific Islanders (PI). Overall, 9% did not have usual source of care [15% in Hispanics, 7% in AA and 5% in Asian/PI compared to 5% in whites (p<0.05)] and 11% were uninsured [18% in Hispanics, 11 in Asian/PI, 10% in AA compared to 4% among white (p<0.05)].

 Overall, 77% percent had a diabetic care plan developed by a health care provider, while only 46% had a copy of this plan. Fewer Asian/PI and Hispanics their providers developed their diabetes care plan (66% and 69% respectively) compared to 87% in white (p<0.05).  There was no racial difference in the percent who had written diabetes care plan (48% in AA, 47% in Hispanics, 46% in Asian/PI and 43% in white, p>0.05).

 Delay in needed care for diabetes was reported by 19%, with highest report being among Hispanics (24%) and Asian (21%) compared to white (13%) (p<0.05). Of those with delay in care, 53% was due to cost/no insurance [68% in Hispanics and 55% in other race compared to 45% in whites (p=0.02)].

 Delay in prescription medication was reported by 18% overall and was highest among other race (30%), AA (21%) and Hispanics (20%) compared to white (17%) (p=0.001). Of those with delay getting medication, 60% was due to cost/no insurance [78% in Hispanics and 55% in AA compared to 46% in whites (p=0.001)].

 Implications: Delays in treatment is prevalent in the U.S.  Understanding the factors associated with delayed care and treatment of diabetes is important as the failure to receive care can lead to poorer outcomes, costly treatment and death.  Possible approaches to help overcome delays include the development of guidelines, motivation and support of patient self-management, and education for both physicians and diabetics.