Why the Ethnic Disparity in A1c’s?

Hispanics and African Americans have higher A1c's than whites. That disparitycontributes to the unfortunate fact that in the U.S., approximately ten percentof racial differences in mortality have been attributed to diabetes.

The reasonfor that sad statistic was the subject of a recent study by researchers from theUniversity of Michigan, who sent detailed questionnaires to 1,901 AfricanAmerican, Latino, and white people with diabetes aged 55 and older.

The researchers found that among the participants taking diabetes medications,Latinos had an average A1c of 8.14%, African Americans averaged 8.07%, andwhites averaged 7.22%. An even bigger disparity was found among the participantswho were between 55 and 64, too young for Medicare. Those African Americans hadaverage A1c's of 8.96%, compared to Latinos at 8.91% and whites at 7.46%.

In searching for explanations, the researchers looked into the subjects'education level, household income, mental health, insurance coverage, quality ofhealth care, medication regimens, exercise, and diet. They also looked at theiremotional responses to diabetes and how well they took their prescribed diabetesmedications.

The researchers learned that Latinos are more likely than whites to experiencediabetes-related emotional distress. African-Americans, on the other hand, areless likely to take their prescribed medicines. According to the currentfindings, differences in income and education level did not contribute to theglucose control differences. In fact, all the surveyed factors accounted foronly fourteen percent of the African American disparity and nineteen percent ofthe Latino disparity.

The authors concluded that unassessed factors, such as genetics, stress levelsand other environmental factors, intensity of medication regimens, and qualityof insurance coverage, must account for the remaining over eighty percent ofdisparity in A1c's among the three groups.

Sources: WebMD, University of Michigan news release, Science Daily; Archives ofInternal Medicine, September 2007

Editor's Note: Did they look at access to diabetes education programs?

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