Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 2.2 Disparities in Diabetes Prevalence Rates


Diabetes, a priority condition in the U.S., is a group of diseases characterized by high blood glucose levels, resulting from defects in insulin secretion or action (Centers for Disease Control and Prevention [CDC] 2007a). It is the sixth leading cause of death in the U.S., and incurs annual medical costs of over $100 billion (Agency for Healthcare Research and Quality [AHRQ] 2007; Caravalho and Saylor 2000; Peek et al 2007). More than 20.8 million people are estimated to have diabetes, and prevalence rates have increased rapidly in the past decade (Peek et al 2007).

Racial/ethnic disparities in diabetes prevalence rates are well documented. Based on data from the CDC, Blacks are 2.2 times as likely to have diabetes as Whites (Office of Minority Health [OMH] 2008a, 2008b). Hispanics are also 1.5 times as likely to have diabetes as non-Hispanic Whites (OMH 2008c, Peek et al 2007). Recent CDC data indicate that Native Americans are, on average, 2.3 times as likely as Whites are to have diabetes, although regional data indicate that the prevalence can be much higher for certain groups (OMH 2008d). In contrast, Asian Americans generally have the same rate of diabetes as Whites (OMH 2008e).

Published reports of differences in diabetes rates that reflect individual factors beyond race/ethnicity (as illustrated in the conceptual model) are more limited, although there is some evidence of gender differences. For example, a CDC report indicates that adult women experience lower prevalence rates of diabetes overall than men (CDC 2007a; American Diabetes Association 2008a), but the pattern differs according to race and ethnicity: Blacks, younger and older women (≤44, ≥65) experience higher diabetes rates than men in the same age groups (OMH 2008b). Among Hispanics, women have higher age-adjusted rates of diabetes overall than men (OMH 2008c).

Evidence of gender differences in diabetes rates based on age indicates differences between midlife adults (45–64) and older, Medicare-insured adults (>65). For example, among Black adults, the prevalence of diabetes is lowest among midlife adults, but highest among older adults ages 65–74 (OMH 2008a). The overall trend of higher diabetes rates among Black women than Black men is also reversed among midlife adults, where the prevalence of diabetes is slightly higher in men than in women.

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