Racial/Ethnic- and Education-Related Disparities in the Control of Risk Factors for Cardiovascular Disease Among Individuals With Diabetes

Department of Economics, University at Albany, State University of New York, Albany, New York, USA.
Diabetes care (Impact Factor: 8.42). 12/2011; 35(2):305-12. DOI: 10.2337/dc11-1405
Source: PubMed


There is limited information on whether recent improvements in the control of cardiovascular disease (CVD) risk factors among individuals with diabetes have been concentrated in particular sociodemographic groups. This article estimates racial/ethnic- and education-related disparities and examines trends in uncontrolled CVD risk factors among adults with diabetes. The main racial/ethnic comparisons made are with African Americans versus non-Latino whites and Mexican Americans versus non-Latino whites.
The analysis samples include adults aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 1988-1994 and the NHANES 1999-2008 who self-reported having diabetes (n = 1,065, NHANES 1988-1994; n = 1,872, NHANES 1999-2008). By use of logistic regression models, we examined the correlates of binary indicators measuring 1) high blood glucose, 2) high blood pressure, 3) high cholesterol, and 4) smoking.
Control of blood glucose, blood pressure, and cholesterol improved among individuals with diabetes between the NHANES 1988-1994 and the NHANES 1999-2008, but there was no change in smoking prevalence. In the NHANES 1999-2008, racial/ethnic minorities and individuals without some college education were more likely to have poorly controlled blood glucose compared with non-Latino whites and those with some college education. In addition, individuals with diabetes who had at least some college education were less likely to smoke and had better blood pressure control compared with individuals with diabetes without at least some college education.
Trends in CVD risk factors among individuals with diabetes improved over the past 2 decades, but racial/ethnic- and education-related disparities have emerged in some areas.

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    • "Demographic background characteristics including gender (female = 1, male = 0), marital status (married = 1, other status = 0), and education received in their country of origin and/or in the United States (years); acculturation indicated by time living in the United States (years); diabetes severity indicated by time since diagnosis (years), diabetes treatment method (diet and exercise; medications; insulin) and number of comorbidities were used as control variables. We selected these variables because prior research demonstrated their role in shaping health or diabetes outcomes (American Diabetes Association, 2013; Chatterji et al., 2012; Chun, Chesla, & Kwan, 2011; Kalyani, Saudek, Brancati, & Selvin, 2010; Kiecolt-Glaser & Newton, 2001). Although the literature suggests associations between socioeconomic status and health, we did not control for household income, a measure of socioeconomic status, to avoid problems of multicollinearity. "
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