Racial differences in spatial patterns for poor glycemic control in the Southeastern United States

Area of Science:

• Public Health
• Health Disparities
• Spatial Epidemiology

Background:

• Racial minorities often experience poorer health outcomes, with limited understanding of spatial influences on these disparities.
• Diabetes management and outcomes, particularly glycemic control, are critical public health concerns.

Purpose of the Study:

• To investigate the contribution of spatial patterns to disparities in diabetes outcomes within the Southeastern United States.
• To analyze how spatial variations influence differences in glycemic control between racial groups.

Main Methods:

• Analysis of data from 64,022 non-Hispanic black (NHB) and non-Hispanic white (NHW) veterans with diabetes in Georgia, Alabama, and South Carolina (2014).
• Logistic regression models were used to assess the explanatory power of spatial random effects beyond demographic and comorbidity covariates.
• County-level data were analyzed for hotspots of uncontrolled Hemoglobin A1c (HbA1c) using the local Moran's I test.

Main Results:

• Overall, 36.5% of veterans had uncontrolled HbA1c, with higher rates in NHB (40.8%) compared to NHW (33.4%).
• NHB veterans had significantly higher odds of uncontrolled HbA1c, even after adjusting for demographics and comorbidities.
• Incorporating spatial effects further reduced the odds ratio for uncontrolled HbA1c in NHB veterans, indicating spatial patterns explain a portion of the disparity.

Conclusions:

• Significant differences in spatial patterns of glycemic control exist between NHB and NHW veterans with type 2 diabetes.
• Spatial effects provide additional explanatory power for disparities in uncontrolled HbA1c beyond traditional risk factors.
• Despite accounting for spatial factors, significant racial disparities in uncontrolled diabetes outcomes persist.