Racial disparities in outcomes seen among diabetics treated by the same physician

Last Updated: 2008-06-13 12:55:31 -0400 (Reuters Health)

NEW YORK (Reuters Health) – Among diabetic patients treated by the same physician, African Americans are less likely than Caucasians to meet treatment goals, Dr. Thomas D. Sequist and colleagues in Boston report in the June 9 issue of the Archives of Internal Medicine.

"Although quality improvement programs can eliminate racial disparities in process measures of DM (diabetes mellitus) care, disparities in intermediate outcomes often persist," the investigators note. Research in this area has focused on the role of hospitals, health plans and regions as mediators of racial disparity, they add, while the role of variation among individual physicians is relatively unexplored.

Their study was conducted at Harvard Vanguard Medical Associates, a group practice of 14 ambulatory health centers. They restricted their analysis to the 90 primary care physicians who cared for at least five black patients and five white patients with diabetes.

The 4556 white patients and 2258 black patients were equally likely to have received annual HbA1c and LDL-C tests, Dr. Sequist’s team reports. They note that blacks were less likely to have been prescribed a statin, but no mention is made with regard to prescriptions for fibrates or other medications.

African Americans were less likely to achieve either ideal or adequate control of HbA1c, LDL-C, and blood pressure (p < 0.001 for each). For example, 63% of African Americans and 71% of Caucasians had an HbA1c < 8.0%. Corresponding rates for an LDL-C < 130 mg/dL were 69% and 75%, and for a blood pressure < 140/90, rates were 57% and 63%.

Statistical analyses showed that patient sociodemographic factors explained 13% to 38% of the racial differences, and within-physician effects accounted for 66% to75% of the differences. "Patients’ clinical characteristics did not play a major role," the authors note.

In an editorial, Dr. Carolyn Clancy, at the Agency for Healthcare Research and Quality in Rockville, Maryland, proposes two possible explanations for the differences observed.

"First, it is quite possible that other aspects of care delivery (eg, medication teaching, communication) were worse for the black patients," she writes. "Second, achieving good control of hemoglobin A1c and LDL-C levels and blood pressure require actively engaged patients and support for sustained behavior changes."

In summary, Dr. Clancy maintains that "eliminating disparities in health care will require that all patients have access to care, as well as physician leadership to assure that the care provided is evidence based, patient centered, effective, consistent, and equitable."

Arch Intern Med 2008;168:1135-1136,1145-1151.