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Socioeconomic status affects racial differences in health literacy, diabetes self-care
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A difference in health literacy and diabetes self-care scores between a cohort of black and white adults with type 2 diabetes can be attributed to differences in several markers of socioeconomic status that go beyond education and income, including job stress, difficulty paying for health care expenses and lack of affordable transportation, according to findings published in the American Journal of Preventive Medicine.
“Our study suggests socioeconomic factors may largely account for black/white racial disparities in diabetes health behaviors, health literacy, and numeracy, but do not account for disparities in HbA1c,” Lyndsay A. Nelson, PhD, research assistant professor of medicine at the Center for Diabetes Translation Research at Vanderbilt University Medical Center, told Endocrine Today. “Social factors beyond the individual may influence differences in glycemic control between white and black adults.”
Nelson and colleagues analyzed data from 444 adults diagnosed with type 2 diabetes, prescribed at least one antidiabetes medication and receiving primary care at Vanderbilt University Medical Center or federally qualified health centers, recruited between 2016 and 2018 (46% black adults). Participants completed the Tool for Assessing Patients’ Stressors, including four items relating to low socioeconomic status, such as a lack of access to affordable transportation, job stress and not having enough money for food, rent or mortgage. Participants also completed validated measures on health literacy and diabetes self-care behaviors and completed questionnaires on diet, physical activity and medication adherence, as well as an HbA1c test. The researchers assessed differences between black and white adults in health literacy, numeracy, self-care and HbA1c using propensity score weighting.
In unweighted analyses, there were no between-race differences in physical activity, self-monitoring of blood glucose or smoking; however, black adults had lower health literacy (P = .039) and numeracy scores (P < .001) and reported lower medication adherence (P = .009), lower use of information for dietary decisions (P = .013) and fewer problem eating behaviors (P < .001) than white adults. Black adults also had a higher HbA1c vs. white adults (mean, 8.86% vs. 8.31%; P = .005).
In weighted analyses, racial differences were attenuated for nearly all outcomes apart from problem eating behaviors (P = .016) and HbA1c (P = .011), according to researchers.
“Among a diverse sample of adults diagnosed with [type 2 diabetes], racial disparities in determinants of diabetes outcomes present in unadjusted analyses largely disappeared after balancing the sample on multiple dimensions of [socioeconomic status],” the researchers wrote. “HbA1c, although attenuated, remained near 0.5% higher among [black adults] relative to [white adults]. This suggests additional factors (eg, racial discrimination in health care) may contribute to the HbA1c disparity.”
The researchers noted that the reverse disparity in so-called problem eating could be due to cultural differences in the perception of eating behaviors as problematic, leading to differential interpretation of scale items.
“In order to reduce health disparities, our results support the recent push for electronic health records to collect data on social determinants of health as well as clinical decision support tools for helping address those factors,” Lindsay S. Mayberry, MS, PhD, assistant professor of medicine at the Center for Diabetes Translation Research at Vanderbilt University Medical Center, told Endocrine Today. “Attending to these may be more influential in ending diabetes disparities.
– by Regina Schaffer
For more information:
Lyndsay A. Nelson, PhD, can be reached at Vanderbilt University Medical Center, 2213 Garland Ave., Nashville, TN 37232; email: Lyndsay.a.nelson@vanderbilt.edu.
Disclosures: One of the study authors reports he serves on an advisory board for EdLogics Inc.
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