Assessing diabetes and factors associated with foregoing medical care among persons with diabetes: Disparities facing American Indian/Alaska native, black, hispanic, low income, and southern adults in the U.S. (2011–2015)

Samuel D. Towne, Jane Bolin, Alva Ferdinand, Emily Joy Nicklett, Matthew Lee Smith, Marcia G. Ory

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Objective: Identify individual- and place-based factors associated with diagnosed diabetes and forgone medical care among those diagnosed with diabetes. Background: Diabetes affects millions of individuals globally. In the U.S. alone the prevalence rate of diagnosed diabetes has more than doubled over the past 20 years (4.2% in 1994 to 10% in 2014). Methods: The Behavioral Risk Factor Surveillance System (2011–2015) was used to identify factors associated with self-reported diabetes diagnoses (ever diagnosed) among U.S. adults. Logistic regression modeled: (1) the likelihood of having diabetes; (2) the likelihood of forgone medical care among those with diabetes, given appropriate medical care has been linked to preventing complications associated with diabetes. Results: Rates of diabetes remained relatively stable from 2011 to 2015. The likelihood of diabetes was higher (p < 0.01) among racial and ethnic minority groups, men, those with lower incomes and those with lower education. Place-based disparities indicating a higher likelihood of having a diagnosis of diabetes were found for those living in rural areas (urban versus rural, unadjusted OR = 0.844–0.908; p < 0.01) and those living in the South (North, Midwest, andWestern/Pacific regions versus the South, unadjusted OR = 0.794–0.889; p < 0.01). Similar results were found with forgone medical care among those diagnosed with diabetes being more likely in the South (North, Midwest, and Western/Pacific regions versus the South, unadjusted OR = 0.542–0.819). In fully-adjusted analyses, the prevalence of diabetes and forgone medical care among those diagnosed with diabetes was higher for those with lower incomes, from several racial/ethnic minority groups, and in the South versus most other regions. Conclusions: Identifying at-risk groups informs targets for prevention and assists efforts to address chronic disease self-management among those already diagnosed with diabetes.

Original languageEnglish (US)
Article number464
JournalInternational journal of environmental research and public health
Volume14
Issue number5
DOIs
StatePublished - May 2017

Keywords

  • Environmental and social predictors
  • Health disparities
  • Place-based disparities

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

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