Disparities in Quality of Care for Midlife Adults (Ages 45–64) Versus Older Adults (Ages >65). 2.3 Disparities in Diabetes Complications


Diabetes can lead to serious complications, including blindness, cardiovascular disease, kidney damage and lower-limb amputations, although proper management and quality care can reduce the risk of complications (CDC 2007a). The majority of disparities literature on diabetes complications focuses on race and ethnicity differences and pays less attention to other factors, such as income. In general, non-White racial and ethnic minorities with diabetes experience higher rates of complications and death from diabetes than Whites. For example, Blacks have 2–4 times the rate of end stage renal disease, blindness, amputations and amputation-related mortality than Whites (Lanting et al 2005; OMH 2008a; Peek et al 2007). Hispanics are 1.6 times as likely as non-Hispanic Whites to die from diabetes (OMH 2008c), and Hispanics have higher rates of renal disease, retinopathy and lower-limb amputations than non-Hispanic Whites (AHRQ 2007; Lanting et al 2005; Peek et al 2007). Among Native Americans, diabetes-related mortality is 2.7 times that of Whites (Peek et al 2007), although this rate can vary based on Native American subgroup and region. In contrast, Asian Americans are 20 percent less likely to die from diabetes than Whites (OMH 2008e), on average, and

The few disparities reports based on other individual factors, such as gender and socioeconomic status, did not always exhibit consistent findings. For example, the OMH reported that White, Black and Hispanic women with diabetes have higher rates of obesity than men (OMH 2008a–c). Another study found that women and men have similar rates of hospital admissions for uncontrolled diabetes, and rates for lower extremity amputations were higher for men (Correa-de-Araujo et al 2006). Using 2001–2004 data, AHRQ also found socioeconomic differences: lower-income individuals were likelier to experience lower-limb amputations than higher-income

Data are limited for disparities in diabetes complications based on age. Few studies stratify results by midlife and older adults, who have very different health insurance coverage situations that may affect outcomes. One recent study, the 2007 State of Diabetes Complications in America Report, reported some differences in diabetes complications between midlife adults (45–64) and older adults (>65). The report found that the prevalence of diabetes complications among those with diagnosed diabetes was higher in the older adults than in the midlife adults. These statistics, however, were not stratified by sociodemographic factors, and thus the report did not provide information on whether the extent of disparities in diabetes complications—based on factors of gender, race or socioeconomic status—differed among these two age groups (American Association of Clinical Endocrinologists

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