Chartbook for Hispanic Health Care

• Thirty years ago, the Heckler Report found that:
  • Among the 14.6 million individuals of Hispanic origin in the United States, the prevalence of diabetes was more than three times the rate in the White population.
  • From available data, it is clear than diabetes is a major health burden contributing to excess morbidity and mortality in the Mexican American population. The data are still inadequate, however, to say with certainty whether this increased prevalence of diabetes is shared by other Hispanic subgroups.

Diabetes Care for Hispanics

• Trends: Data are insufficient to assess trends for most measures of diabetes care for Hispanics.
• Groups With Disparities:
  • Hispanics were less likely than Whites to have their diabetes diagnosed.
  • After diagnosis, Hispanics were less likely than Whites to receive recommended services for diabetes and this disparity was not changing over time.

Recommended Services for Diabetes

Adults age 40 and over with diagnosed diabetes who reported receiving four recommended services for diabetes in the calendar year, by race/ethnicity and by place of birth among Hispanics, 2008-2012

Left Graph:

Right Graph:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2008-2012.
Denominator: Civilian noninstitutionalized population with diagnosed diabetes, age 40 and over.
Note: Data include people with both type 1 and type 2 diabetes. The four recommended services are 2+ hemoglobin A1c tests, foot exam, dilated eye exam, and flu shot. Rates are age adjusted to the 2000 U.S. standard population using two age groups: 40-59 and 60 and over.

• Importance:
  • Regular hemoglobin A1c (HbA1c) tests, foot exams, dilated eye exams, and flu shots help people keep their diabetes under control and avoid diabetic complications.
  • A composite measure is used to track the national rate of receipt of all four of these recommended annual diabetes interventions.
• Trends:
  • From 2008 to 2012, among adults age 40 and over with diagnosed diabetes, improvements were observed overall and among Blacks.
  • However, only slightly more than one-fourth (26.6 percent) of adults with diabetes reported receiving all four recommended services in 2012.
• Groups With Disparities:
  • In 2 of 5 years, including 2012, Hispanics and Blacks were less likely than Whites to receive the recommended services.
  • In all years, foreign-born Hispanics were less likely than U.S.-born Hispanics to receive the recommended services, but these differences were not statistically significant.

Written Diabetes Management Plan

People with current diabetes who have a written diabetes management plan, by Hispanic group and English proficiency, California, 2011-2013 combined

Source: UCLA, Center for Health Policy Research, California Health Interview Survey, 2011-2013.
Denominator: Civilian noninstitutionalized population in California.

• Importance:
  • A successful partnership for diabetes care requires providers to educate patients about daily management of their diabetes. Hence, providers should develop a written diabetes management plan, especially for patients with a history of uncontrolled diabetes.
  • National data on diabetes management and outcomes for some underserved populations are not available from the national data sources in the QDR. These populations include people with limited English proficiency; individuals who speak a language other than English at home; and Hispanic subpopulations. To address some of these data gaps, we show additional data from the California Health Interview Survey.
• Overall Rate: Only 43% of Californians with current diabetes had a written diabetes management plan in 2011-2013.
• Groups With Disparities: Among Hispanic Californians with diabetes, those who spoke English well/very well and not well/not at all were less likely than those who spoke English only to have a written diabetes management plan.

Control of Hemoglobin A1c and Blood Pressure

Adults age 40 and over with diagnosed diabetes with hemoglobin A1c and blood pressure under control, by race/ethnicity, 2003-2006, 2007-2010, and 2011-2012

Left Graph (Hemoglobin A1c <8.0%):

Right Graph (Blood Pressure <140/80 mm Hg):

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, 2003-2006, 2007-2010, and 2011-2012.
Denominator: Civilian noninstitutionalized population with diagnosed diabetes, age 40 and over.
Note: Age adjusted to the 2000 U.S. standard population using two age groups: 40-59 and 60 and over.

• Importance: People diagnosed with diabetes are often at higher risk for other cardiovascular risk factors, such as high blood pressure. Having these conditions in combination with diagnosed diabetes increases the likelihood of complications, such as heart and kidney diseases, blindness, nerve damage, and stroke. Patients who manage their diagnosed diabetes and maintain an HbA1c level <8% and blood pressure <140/80 mm Hg can decrease these risks.
• Overall Rate: Among adults age 40 and over with diagnosed diabetes, 69.2% achieved HbA1c less than 8% and 68.5% achieved blood pressure less than 140/80 mm Hg in 2011-2012.
• Groups With Disparities:
  • In 2003-2006, Blacks and Mexican Americans were less likely than Whites to have their HbA1c under control. Differences in 2007-2010 and 2011-2012 were not statistically significant.
  • In 2007-2010 and 2011-2012, Blacks were less likely than Whites to have their blood pressure under control.

Outcomes of Diabetes Care for Hispanics

• Trends: Most outcomes of diabetes care for Hispanics were improving.
• Groups with Disparities:
  • Hispanics had higher rates of admission than Whites for uncontrolled diabetes and for long-term complications of diabetes. These disparities were narrowing over time.
  • Hispanic adults and White adults had similar rates of admission for short-term complications of diabetes. This represents the elimination of a previously observed disparity.
  • Hispanic children had lower rates of admission than White children and this disparity was not changing over time.
  • Hispanics had higher rates of ESRD due to diabetes than Whites and this disparity was not changing over time.

Hospital Admissions for Uncontrolled Diabetes

Hospital admissions for uncontrolled diabetes without complications per 100,000 population, age 18 and over, by race/ethnicity, 2001-2012

2008 Achievable Benchmark: 5 per 100,000 Population.

Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, State Inpatient Databases, 2001‐2012 disparities analysis files and AHRQ Quality Indicators, modified version 4.4.
Denominator: U.S. resident population age 18 and over.
Note: For this measure, lower rates are better.

• Importance:
  • Individuals who do not achieve good control of their diabetes may develop symptoms that require correction through hospitalization.
  • Admission rates for uncontrolled diabetes may be reduced by better outpatient treatment and patients' tighter adherence to the recommended diet and medication.
• Trends:
  • The rate of hospital admissions for uncontrolled diabetes without complications per 100,000 population decreased from 27.9 in 2001 to 17.3 in 2012.
  • From 2001 to 2012, the rate of hospital admissions per 100,000 population decreased for all populations:
    • For Hispanics, from 46.0 to 26.7.
    • For Blacks, from 88.3 to 53.1.
    • For Whites, from 17.6 to 11.7.
• Groups With Disparities: In all years, the rate of hospital admissions for uncontrolled diabetes was higher for Blacks and Hispanics compared with Whites.
• Achievable Benchmark:
  • The 2008 top 4 State achievable benchmark was 5 admissions per 100,000 population age 18 and over. The top 4 States that contributed to the achievable benchmark are Colorado, Hawaii, Utah, and Vermont.
  • At the current rate, the benchmark could not be met for the total population for approximately 17 years.
  • At the current rates, Whites could not reach the benchmark for 22 years and Blacks would need 20 years. Hispanics could reach the benchmark in 10 years.

End Stage Renal Disease Due to Diabetes

New cases of end stage renal disease due to diabetes, per million population, by ethnicity, 2003-2012

2008 Achievable Benchmark: 90 per Million Population.

Source: National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Renal Data System, 2003-2012.
Denominator: U.S. resident population.
Note: For this measure, lower rates are better. Rates are adjusted by age, sex, and interactions of age and sex.

• Importance: Diabetes is the most common cause of kidney failure. Keeping blood glucose levels under control can prevent or slow the progression of kidney disease. When kidney disease is detected early, medication can slow the disease's progress; when detected late, it commonly progresses to end stage renal disease requiring dialysis or kidney transplantation. While some cases of kidney failure due to diabetes cannot be avoided, other cases reflect inadequate control of blood glucose or delayed detection and treatment of early kidney disease due to diabetes.
• Trends: From 2003 to 2012, the overall rate of new cases of ESRD due to diabetes improved for Hispanics.
• Groups With Disparities: In all years, Hispanics had higher rates than non-Hispanics.
• Achievable Benchmark:
  • The 2008 top 5 State achievable benchmark was 90 per million population. The top 5 States that contributed to the achievable benchmark are Alaska, Maine, New Hampshire, Rhode Island, and Vermont.
  • At current rates of change, the benchmark would not be achieved overall or by any ethnic group for decades.

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