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Int. J. Environ. Res. Public Health 2017, 14(5), 464; doi:10.3390/ijerph14050464

Assessing Diabetes and Factors Associated with Foregoing Medical Care among Persons with Diabetes: Disparities Facing American Indian/Alaska Native, Black, Hispanic, Low Income, and Southern Adults in the U.S. (2011–2015)

1
Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX 77846, USA
2
Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77846, USA
3
School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA
4
Institute of Gerontology, Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA 30602, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Received: 16 February 2017 / Revised: 20 April 2017 / Accepted: 22 April 2017 / Published: 26 April 2017
(This article belongs to the Special Issue Aging and Health Promotion)
View Full-Text   |   Download PDF [787 KB, uploaded 26 April 2017]   |  

Abstract

Objective: Identify individual- and place-based factors associated with diagnosed diabetes and forgone medical care among those diagnosed with diabetes. Background: Diabetes affects millions of individuals globally. In the U.S. alone the prevalence rate of diagnosed diabetes has more than doubled over the past 20 years (4.2% in 1994 to 10% in 2014). Methods: The Behavioral Risk Factor Surveillance System (2011–2015) was used to identify factors associated with self-reported diabetes diagnoses (ever diagnosed) among U.S. adults. Logistic regression modeled: (1) the likelihood of having diabetes; (2) the likelihood of forgone medical care among those with diabetes, given appropriate medical care has been linked to preventing complications associated with diabetes. Results: Rates of diabetes remained relatively stable from 2011 to 2015. The likelihood of diabetes was higher (p < 0.01) among racial and ethnic minority groups, men, those with lower incomes and those with lower education. Place-based disparities indicating a higher likelihood of having a diagnosis of diabetes were found for those living in rural areas (urban versus rural, unadjusted OR = 0.844–0.908; p < 0.01) and those living in the South (North, Midwest, and Western/Pacific regions versus the South, unadjusted OR = 0.794–0.889; p < 0.01). Similar results were found with forgone medical care among those diagnosed with diabetes being more likely in the South (North, Midwest, and Western/Pacific regions versus the South, unadjusted OR = 0.542–0.819). In fully-adjusted analyses, the prevalence of diabetes and forgone medical care among those diagnosed with diabetes was higher for those with lower incomes, from several racial/ethnic minority groups, and in the South versus most other regions. Conclusions: Identifying at-risk groups informs targets for prevention and assists efforts to address chronic disease self-management among those already diagnosed with diabetes. View Full-Text
Keywords: health disparities; environmental and social predictors; place-based disparities health disparities; environmental and social predictors; place-based disparities
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MDPI and ACS Style

Towne, S.D.; Bolin, J.; Ferdinand, A.; Nicklett, E.J.; Smith, M.L.; Ory, M.G. Assessing Diabetes and Factors Associated with Foregoing Medical Care among Persons with Diabetes: Disparities Facing American Indian/Alaska Native, Black, Hispanic, Low Income, and Southern Adults in the U.S. (2011–2015). Int. J. Environ. Res. Public Health 2017, 14, 464.

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