Harris M I
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA.
Diabetes Care. 2001 Mar;24(3):454-9. doi: 10.2337/diacare.24.3.454.
To evaluate health care access and utilization and health status and outcomes for type 2 diabetic patients according to race and ethnicity and to determine whether health status is influenced by health care access and utilization.
National samples of Caucasians, African-Americans, and Mexican-Americans were studied in the third National Health and Nutrition Examination Survey. Information on medical history and treatment of diabetes, health care access and utilization, and health status and outcomes was obtained by structured questionnaires and by clinical and laboratory assessments.
Almost all patients in each race and ethnic group had one primary source of ambulatory medical care (92-97%), saw one physician at this source (83-92%), and had at least semiannual physician visits (83-90%). Almost all patients > or = 65 years of age had health insurance (99-100%), and for those patients < 65 years of age, Caucasians (91%) and African-Americans (89%) had higher rates of coverage than Mexican-Americans (66%). Rates of treatment with insulin or oral agents (71-78%), eye examination in the previous year (61-70%), blood pressure check in the previous 6 months (83-89%), and the proportion of hypertension that was diagnosed (84-91%) were similar for each race and ethnic group. Lower proportions of African-Americans and Mexican-Americans self-monitored their blood glucose (insulin-treated, 27 vs. 44% of Caucasians), had their cholesterol checked (62-68 vs. 81%), and had their dyslipidemia diagnosed (45 vs. 58%). African-American and Mexican-American patients had a somewhat higher proportion than Caucasian patients, with HbA1c > or = 7% (58-66 vs. 55%), blood pressure > or = 140/90 mmHg among those with diagnosed hypertension (60-65 vs. 55%), and clinical proteinuria (11-14 vs. 5%). In contrast, they had better levels of total cholesterol (> or = 240 mg/dl) (28 -30 vs. 34%) and HDL cholesterol (> or = 45 mg/dl) (46 -59 vs. 38%), and African-American and Mexican-American men were less overweight than Caucasian men (BMI > or = 30) (34-37 vs. 44%), although the opposite was true for women. LDL cholesterol levels and the proportion of patients who smoked cigarettes or were hospitalized in the past year were similar among all three groups. In logistic regression analysis, there was little evidence that levels of blood glucose, blood pressure, lipids, or albuminuria were associated with access to or utilization of health care or with socioeconomic status.
There are some differences by race and ethnicity in health care access and utilization and in health status and outcomes for adults with type 2 diabetes. However, the magnitude of these differences pale in comparison with the suboptimal health status of all three race and ethnic groups relative to established treatment goals. Health status does not appear to be influenced by access to health care.
根据种族和民族评估2型糖尿病患者的医疗保健可及性与利用率、健康状况及结局，并确定健康状况是否受医疗保健可及性与利用率的影响。
在第三次全国健康和营养检查调查中对白人、非裔美国人及墨西哥裔美国人的全国样本进行了研究。通过结构化问卷以及临床和实验室评估获取了有关糖尿病病史与治疗、医疗保健可及性与利用率、健康状况及结局的信息。
每个种族和民族群体中几乎所有患者都有一个门诊医疗的主要来源（92% - 97%），在此来源处看一位医生（83% - 92%），并且至少每半年看一次医生（83% - 90%）。几乎所有年龄≥65岁的患者都有健康保险（99% - 100%），对于年龄＜65岁的患者，白人（91%）和非裔美国人（89%）的保险覆盖率高于墨西哥裔美国人（66%）。每个种族和民族群体使用胰岛素或口服药物治疗的比例（71% - 78%）、前一年进行眼部检查的比例（61% - 70%）、前6个月进行血压检查的比例（83% - 89%）以及已诊断高血压的比例（84% - 91%）相似。非裔美国人和墨西哥裔美国人自我监测血糖的比例较低（接受胰岛素治疗的患者中，分别为27%和44%，而白人为44%），进行胆固醇检查的比例较低（分别为62% - 68%和81%），被诊断为血脂异常的比例较低（分别为45%和58%）。非裔美国人和墨西哥裔美国患者中糖化血红蛋白≥7%的比例（58% - 66%）、已诊断高血压患者中血压≥140/90 mmHg的比例（60% - 65%）以及临床蛋白尿的比例（11% - 14%）略高于白人患者（分别为55%、55%和5%）。相比之下，他们的总胆固醇水平（≥240 mg/dl）（分别为28% - 30%和34%）和高密度脂蛋白胆固醇水平（≥45 mg/dl）（分别为46% - 59%和38%）较好，并且非裔美国人和墨西哥裔美国男性的超重比例低于白人男性（体重指数≥30）（分别为34% - 37%和44%），不过女性情况相反。所有三个群体中低密度脂蛋白胆固醇水平以及过去一年吸烟或住院患者的比例相似。在逻辑回归分析中，几乎没有证据表明血糖、血压、血脂或蛋白尿水平与医疗保健的可及性或利用率或社会经济地位相关。
在2型糖尿病成年患者的医疗保健可及性与利用率、健康状况及结局方面，存在一些种族和民族差异。然而，与所有三个种族和民族群体相对于既定治疗目标而言欠佳的健康状况相比，这些差异的程度显得微不足道。健康状况似乎不受医疗保健可及性的影响。
