Woolton Lee|Jennifer Lloyd|Katherine Giuriceo|Timothy Day|William H. Shrank|Rahul Rajkumar
Systematic review and meta?analysis of patient race/ethnicity, socioeconomics, and quality for adult type 2 diabetes
Centers for Medicare and Medicaid Services|Centers for Medicare and Medicaid Services|Centers for Medicare and Medicaid Services|Centers for Medicare and Medicaid Services|Humana (United States)|Blue Cross and Blue Shield of North Carolina Foundation
abstract objective review evidence association performance eight indicators diabetes care patients raceethnicity socioeconomic characteristics data source studies adult patients type 2 diabetes medline published january 1 2000 december 31 2018 study design systematic review metaanalysis regressionbased studies including raceethnicity income education explanatory variables metaanalysis used quantify differences performance associated patient raceethnicity socioeconomic characteristics systematic review used identify potential mechanisms disparities data collection two coauthors separately conducted abstract screening study exclusions data extraction scoring retained studies estimates retained studies extracted applicable standardized converted odds ratios standard errors principal findings performance intermediate outcomes process measures frequently exhibited differences raceethnicity even adjustment socioeconomic lifestyle health factors metaanalyses showed black patients lower odds hba1c blood pressure bp control range 067068 p lt 05 higher odds receiving eye foot examination range 122147 p lt 05 relative white patients high school degree associated higher odds hba1c control receipt eye examinations compared patients without degree metaanalyses income included handful studies inconsistently associated diabetes care performance differences diabetes performance appear related accessrelated factors uninsurance lacking usual source care food insecurity tradeoffs low incomes lower adherence among younger healthier diabetes patients conclusions patient raceethnicity education associated differences diabetes quality measures depending approach used rate providers adjusting patient characteristics may penalize reward providers based populations serve