Gender and Racial Disparities in the Management of Diabetes Mellitus Among Medicare Patients

Chou, Ann F.; Brown, Arleen F.; Jensen, Roxanne E.; Shih, Sarah; Pawlson, Greg; Scholle, Sarah Hudson

doi:10.1016/j.whi.2007.03.003

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Volume 17, Issue 3 , Pages 150-161, May 2007

Gender and Racial Disparities in the Management of Diabetes Mellitus Among Medicare Patients

Ann F. Chou, PhD, MPH
- Department of Health Administration and Policy, College of Public Health and College of Medicine, University of Oklahoma
- Corresponding Author: Ann F. Chou. Department of Health Administration and Policy, College of Public Health and College of Medicine, University of Oklahoma, 801 NE 13^th St., CHB 355, Oklahoma City, OK 73120, Phone: 405-271-2115; Fax: 405-271-1868
Arleen F. Brown, MD, PhD
- Division of General Internal Medicine and Health Services Research, University of California
Roxanne E. Jensen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
Sarah Shih, MPH
- The National Committee for Quality Assurance 2000 L St., Suite 500, Washington, DC
Greg Pawlson, MD, MPH
- The National Committee for Quality Assurance 2000 L St., Suite 500, Washington, DC
Sarah Hudson Scholle, DrPH, MPH
- The National Committee for Quality Assurance 2000 L St., Suite 500, Washington, DC

Received 21 December 2006; received in revised form 11 January 2007; accepted 23 March 2007. published online 10 May 2007.

Background

Racial/ethnic disparities in diabetes care have been demonstrated in several settings, but few studies have evaluated whether racial/ethnic differences vary by gender. The objective of this study is to understand gender and racial effects on diabetes care for Medicare managed care beneficiaries.

Methods

Using data from: (1) Healthcare Effectiveness Data and Information Set (HEDIS®); (2) Medicare Enrollment Files; and (3) U.S. Census, hierarchical generalized linear analyses were conducted to model the six HEDIS comprehensive diabetes care quality indicators, including processes of care and intermediate outcome measures, as a function of gender and race/ethnicity.

Results

Women were more likely to have received HbA_1c screening or eye examination, but less likely to have LDL control at <100 mg/dL, compared to men. Racial disparities favored whites in five measures, where African Americans were less likely to have received HbA_1c screening, eye examination, cholesterol screening, or achieve adequate HbA_1c control or LDL control at <100 mg/dL. Enrollees in managed care plans where African Americans constituted more than 20% of their insured population tended to have lower likelihood of meeting the HbA_1c screening, HbA_1c control, and eye examination measures.

Conclusions and Discussion

Gender and racial disparities in performance indicators were present among persons enrolled in Medicare managed care. White women were more likely to have met the performance measures related to process of care, but African Americans fared worse in both process of care and intermediate health outcome measures, compared to their white counterparts. Poor performance in cholesterol control observed in women of both races suggests the possibility of less intensive cholesterol treatment in women. The differences in the pattern of care demonstrate the need for interventions tailored to address gender and race/ethnicity.

Key Words: Diabetes, Racial disparities, Gender disparities, Cardiovascular disease, Quality