Abstract
Background
Diabetes is increasingly prevalent among women of reproductive age, yet little is
known about quality of diabetes care for this population at increased risk of diabetes
complications and poor maternal and infant health outcomes. Previous studies have
identified racial/ethnic disparities in diabetes care, but patterns among women of
reproductive age have not been examined.
Methods
This retrospective cohort study analyzed 2016 data from Kaiser Permanente Northern
California, a large integrated delivery system. Outcomes were quality of diabetes
care measures—glycemic testing, glycemic control, and medication adherence—among women
ages 18 to 44 with type 1 or type 2 diabetes (N = 9,923). Poisson regression was used to estimate the association between patient
race/ethnicity and each outcome, adjusting for other patient characteristics and health
care use.
Results
In this cohort, 83% of participants had type 2 diabetes; 31% and 36% of women with
type 2 and type 1 diabetes, respectively, had poor glycemic control (hemoglobin A1c
of ≥9%), and approximately one-third of women with type 2 diabetes exhibited nonadherence
to diabetes medications. Compared with non-Hispanic White women with type 2 diabetes,
non-Hispanic Black women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1–1.3)
and Hispanic women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1–1.3) were
more likely to have poor control. Findings among women with type 1 diabetes were similar.
Conclusions
Our findings indicate opportunities to decrease disparities and improve quality of
diabetes care for reproductive-aged women. Elucidating the contributing factors to
poor glycemic control and medication adherence in this population, particularly among
Black, Hispanic, and Asian women, should be a high research and practice priority.
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Biography
Cassondra J. Marshall, DrPH, MPH, is an Assistant Professor of Maternal, Child, and Adolescent Health at UC Berkeley School of Public Health. Her research interests include patient-centered family planning services and the prevention and management of chronic disease among women of reproductive age.
Biography
Hector P. Rodriguez, PhD, MPH, is Professor of Health Policy and Management, UC Berkeley School of Public Health. He specializes in organizational analysis and performance measurement in health care delivery and local public health systems.
Biography
Wendy Dyer, MS, is a senior data consultant at Kaiser Permanente Northern California Division of Research.
Biography
Julie A. Schmittdiel, PhD, MA, is a research scientist at Kaiser Permanente, Division of Research, specializing in diabetes care and prevention research. She is Director, Health Delivery Systems Center for Diabetes Translational Research, and Associate Director, Delivery Science Fellowship Program.
Article info
Publication history
Published online: April 24, 2020
Accepted:
March 13,
2020
Received in revised form:
March 12,
2020
Received:
May 28,
2019
Footnotes
Funded by The Permanente Medical Group and the Kaiser Permanente Northern California Division of Research. Dr. Schmittdiel received support from the Health Systems Center for Diabetes Translational Research (P30DK092924). The authors have no conflict of interests to report.
Identification
Copyright
© 2020 Jacobs Institute of Women's Health. Published by Elsevier Inc.
