Department of Family Medicine, Oregon Health & Science University, Portland, OR.
Social Interventions Research and Evaluation Network, University of California, San Francisco, San Francisco, CA.
Diabetes Care. 2022 Jul 7;45(7):1568-1573. doi: 10.2337/dc21-2483.
The purpose of the study is to examine diabetes screening and monitoring among Latino individuals as compared with non-Latino White individuals and to better understand how we can use neighborhood data to address diabetes care inequities.
This is a retrospective observational study linked with neighborhood-level Latino subgroup data obtained from the American Community Survey. We used generalized estimating equation negative binomial and logistic regression models adjusted for patient-level covariates to compare annual rates of glycated hemoglobin (HbA1c) monitoring for those with diabetes and odds of HbA1c screening for those without diabetes by ethnicity and among Latinos living in neighborhoods with low (0.0-22.0%), medium (22.0-55.7%), and high (55.7-98.0%) population percent of Mexican origin.
Latino individuals with diabetes had 18% higher rates of HbA1c testing than non-Latino White individuals with diabetes (adjusted rate ratio [aRR] 1.18 [95% CI 1.07-1.29]), and Latinos without diabetes had 25% higher odds of screening (adjusted odds ratio 1.25 [95% CI 1.15-1.36]) than non-Latino White individuals without diabetes. In the analyses in which neighborhood-level percent Mexican population was the main independent variable, all Latinos without diabetes had higher odds of HbA1c screening compared with non-Latino White individuals, yet only those living in low percent Mexican-origin neighborhoods had increased monitoring rates (aRR 1.31 [95% CI 1.15-1.49]).
These findings reveal novel variation in health care utilization according to Latino subgroup neighborhood characteristics and could inform the delivery of diabetes care for a growing and increasingly diverse Latino patient population. Clinicians and researchers whose work focuses on diabetes care should take steps to improve equity in diabetes and prevent inequity in treatment.
本研究旨在比较拉丁裔个体与非拉丁裔白种个体的糖尿病筛查和监测情况，并深入了解如何利用社区数据来解决糖尿病护理的不平等问题。
这是一项回顾性观察性研究，通过与从美国社区调查中获得的邻里层面拉丁裔亚组数据相联系。我们使用广义估计方程负二项式和逻辑回归模型，根据患者水平的协变量进行调整，以比较糖尿病患者的糖化血红蛋白（HbA1c）监测年度率和无糖尿病患者的 HbA1c 筛查几率，同时按族裔和居住在墨西哥裔人口比例分别为低（0.0-22.0%）、中（22.0-55.7%）和高（55.7-98.0%）的社区的拉丁裔个体进行分层比较。
与患有糖尿病的非拉丁裔白种个体相比，患有糖尿病的拉丁裔个体的 HbA1c 检测率高出 18%（调整后的比率比[ARR]1.18[95%置信区间 1.07-1.29]），而没有糖尿病的拉丁裔个体的筛查几率高出 25%（调整后的比值比[OR]1.25[95%置信区间 1.15-1.36]），而非没有糖尿病的非拉丁裔白种个体。在以邻里层面的墨西哥裔人口比例为主要自变量的分析中，所有没有糖尿病的拉丁裔个体的 HbA1c 筛查几率均高于非拉丁裔白种个体，但只有居住在墨西哥裔人口比例较低的社区的个体的监测率有所增加（ARR 1.31[95%置信区间 1.15-1.49]）。
这些发现揭示了根据拉丁裔亚组社区特征，医疗保健利用情况存在新的差异，这可能为日益增长且日益多样化的拉丁裔患者群体提供糖尿病护理服务。关注糖尿病护理工作的临床医生和研究人员应采取措施，改善糖尿病治疗的公平性，防止治疗上的不平等。
