Disparities in self-monitoring of blood glucose among low-income ethnic minority populations with diabetes, United States
Department of Quantitative Health Sciences
Medical Subject Headings
Adolescent; Adult; African Americans; Aged; Behavioral Risk Factor Surveillance System; Blood Glucose Self-Monitoring; European Continental Ancestry Group; Female; Healthcare Disparities; Hispanic Americans; Humans; Income; Male; Middle Aged; Minority Groups; Poverty; United States; Young Adult
Bioinformatics | Biostatistics | Epidemiology | Health Services Research
BACKGROUND: In adults with insulin-treated diabetes, self-monitoring of blood glucose (SMBG) rates may be lower in minority or low-income populations, but the effect of income on racial/ethnic differences in SMBG is unknown.
METHODS: We assessed whether racial/ethnic differences in SMBG vary by income among adults with insulin-treated diabetes by using Behavioral Risk Factor Surveillance System data from 2000 through 2004. We measured the prevalence of SMBG at least once per day among 16,630 adults aged > or = 19 years with insulin-treated diabetes.
RESULTS: At incomes > or = $20,000, Hispanics and non-Hispanic Blacks reported similar but lower SMBG rates than did non-Hispanic Whites (78%, 77%, 85%; P < or = .01). However, among those with income < $20,000, Hispanics performed SMBG substantially less than did Blacks or Whites (65%, 79%, 85%; P < or = .01). Racial/ ethnic differences in SMBC persisted after adjustment for age, sex, education, health insurance, health status, survey period, and diabetes measures. Receipt of diabetes education varied significantly by race/ethnicity in the income < $20,000 group only (Hispanics 49%, Blacks 64%, Whites 62%; P < .001). Low-income Hispanics with limited English proficiency had lower SMBG and diabetes education rates than did those with English proficiency (61% vs 79% and 44% vs 58%, respectively).
CONCLUSIONS: Among US adults with insulin-treated diabetes, Hispanics and Blacks performed daily SMBG less frequently than did Whites. Stratification by income revealed a disparity gradient in the income < $20,000 group: SMBG rates decreased from Whites to Blacks to Hispanics. Low-income Hispanics with limited English proficiency are at greater risk for reduced SMBG than are those proficient in English.
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Citation: Ethn Dis. 2009 Spring;19(2):97-103.