Diabetes, CVD control has improved but ethnic disparities persist

Expanding Medicare coverage may reduce ethnic, socioeconomic differences in health outcomes.

Adults with diabetes and cardiovascular disease experienced significant improvements in blood pressure, cholesterol and glycemic control from 1999 to 2006, but racial, ethnic and socioeconomic disparities persisted.

However, Medicare coverage for adults aged 65 years and older significantly reduced these disparities, and researchers suggested that “expanding insurance coverage before age 65 years may reduce racial, ethnic and socioeconomic differences in important health outcomes for adults with CVD and diabetes.”

The researchers analyzed data on more than 6,000 adults aged 40 to 85 years who participated in the National Health and Nutrition Examination Survey 1999 to 2006. The goal was to assess trends from 1999 to 2006 and changes in health disparities before and after eligibility for Medicare coverage at age 65 years.

During the study period, improvements in disease control ranged from 10.3% for BP control among adults with hypertension to 21% for glycemic control among those with diabetes. These improvements “probably have prevented adverse outcomes, increased life expectancy and provided considerable value to society.”

The findings were published in Annals of Internal Medicine.

Medicare coverage reduced some disparities

Although control rates improved from 1999 to 2006 for blacks, Hispanics and less-educated adults, rates remained worse compared with whites. The gap in glycemic control widened between whites and Hispanics (P=.042). Less-educated adults had significantly worse glycemic control and higher systolic BP compared with more-educated adults.

Disparities in disease control narrowed once adults aged 65 years and older became eligible for Medicare.

Differences between black and white adults in systolic BP (4.2 mm Hg reduction) and HbA1c levels (0.7% reduction) were smaller among adults aged 65 years and older compared with younger adults. The gap in HbA1c levels also narrowed among whites and Hispanics once adults had Medicare coverage.

However, not all gaps narrowed after Medicare coverage. For example, education-related gaps in BP between older and younger adults persisted regardless of age.

“These findings provide strong circumstantial evidence that universal health insurance coverage sharply narrows disparities,” Ashwini R. Sehgal, MD, director of The Center for Reducing Health Disparities at Case Western Reserve University in Cleveland, wrote in an accompanying editorial.

The researchers emphasized a need for more focused efforts to improve the quality of care for black, Hispanic and less-educated adults.

McWilliams JM. Ann Intern Med. 2009;150:505-515.

Sehgal AR. Ann Intern Med. 2009;150:561-562.