Black And White Diabetes Patients Being Treated Differently By Same Physicians

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Main Category: Diabetes
Also Included In: Blood / Hematology;  Cholesterol
Article Date: 10 Jun 2008 - 0:00 PST

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According to a study published in the Archives of Internal Medicine, physicians are treating black diabetes patients differently than white diabetes patients. Thomas D. Sequist, M.D., M.P.H. (Harvard Vanguard Medical Associates, Boston) and colleagues found that black patients are less likely to achieve long-term control of their blood glucose, blood cholesterol and blood pressure levels compared to their white counterparts - even if the same physician is presiding over the treatment.

In previous studies, researchers have noted differences among races in the quality of diabetes treatment. For example, it is documented that black patients are not as likely as white patients to receive standard diabetes tests, such as hemoglobin A1C testing (HbA1C, measures blood glucose control over time) and lipid testing. They are also less likely to achieve the treatment goals of controlling levels of blood pressure, cholesterol and blood glucose. Further, when comparing rates of developing eye and kidney diseases related to diabetes and rates of amputations of the lower extremities due to diabetes, black patients fare worse than white patients. Sequist and colleagues note that, "Identifying the underlying reasons and potential solutions for these differences in quality of care and outcomes is a high priority."

To further investigate the relationship between diabetes treatment and race, Sequist and colleagues analyzed electronic medical records from 4,556 white patients and 2,258 black patients who were 18 years of age or older and had seen a physician in the last two years. All of the patients had diabetes, and they were treated by 90 primary care physicians in eastern Massachusetts who treated at least five black and five white patients.

The researchers found similar rates of testing for low-density lipoprotein cholesterol (LDL, also known as "bad" cholesterol) and HbA1C among black and white patients. There was a noted difference, however, in the likelihoods of reaching the commonly accepted benchmarks for controlling the important aforementioned levels. About 47% of white patients white patients and 39% of black patients achieved control of HbA1C, 57% and 45%, respectively achieved control of LDL cholesterol, and 30% and 24%, respectively, achieved control of blood pressure.

Statistical models revealed that, "Patient sociodemographic factors explained 13 percent to 38 percent of the racial differences in these measures, whereas within-physician effects accounted for 66 percent to 75 percent of the differences." According to the authors, this indicates that, "Racial differences in outcomes were not related to black patients differentially receiving care from physicians who provide a lower quality of care, but rather that black patients experienced less ideal or even adequate outcomes than white patients within the same physician panel."

"Our data suggest that the problem of racial disparities is not characterized by only a few physicians providing markedly unequal care, but that such differences in care are spread across the entire system, requiring the implementation of system-wide solutions," conclude the authors. "Efforts to eliminate these disparities, including race-stratified performance reports and programs to enhance care for minority patients, should be addressed to all physicians."

An accompanying editorial, written by Carolyn Clancy, M.D. (Agency for Healthcare Research and Quality, Rockville, Md.), describes the findings by Sequist and colleagues as "important" and "provocative". She writes:

"They now have an opportunity to examine physicians' reactions and how care changes when physicians are provided feedback on their performance. 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."

Physician Performance and Racial Disparities in Diabetes Mellitus Care
Thomas D. Sequist; Garrett M. Fitzmaurice; Richard Marshall; Shimon Shaykevich; Dana Gelb Safran; John Z. Ayanian
Archives of Internal Medicine (2008). 168[11]:1145 - 1151.
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Written by: Peter M Crosta
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