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POPULATIONS AT RISK
Racial/Ethnic Differences in Multiple Self-Care Behaviors in Adults with Diabetes
Chiagozie Nwasuruba, MD 1, Mokbul Khan, PhD 2, and Leonard E. Egede, MD, MS 2,3
1Department of Medicine, University of Texas Health Center at Tyler, Tyler, TX, USA; 2Charleston VA TREP, Ralph H. Johnson VA Medical Center, Charleston, SC, USA; 3Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Room 280H, Charleston, SC 29425, USA.
OBJECTIVE: To assess racial/ethnic differences in multiple diabetes self-care behaviors.
DESIGN: Cross-sectional study.
PARTICIPANTS: 21,459 participants with diabetes in the 2003 Behavioral Risk Factor Surveillance survey.
MEASUREMENTS: The study assessed self-care behaviors including physical activity, fruits/vegetables consumption, glucose testing, and foot examination, as well as a composite of the 4 self-care behaviors across racial/ethnic groups. Multiple logistic regression was used to assess the independent association between race/ethnicity, the composite variable, and each self-care behavior controlling for covariates. STATA was used for statistical analysis.
RESULTS: Overall, 6% engaged in all 4 self-care behaviors, with a range of 5% in non-insulin users to 8% in insulin users. Blacks were less likely to exercise (OR 0.63, 95% CI 0.51, 0.79), while Hispanics and others were not significantly different from whites. Hispanics (OR 0.64, 95% CI 0.49, 0.82) and others (OR0.69, 95% CI 0.49, 0.96) were less likely to do home glucose testing, while blacks were not significantly different from whites. Blacks (OR 1.42, 95% CI 1.12,1.80) were more likely to do home foot examinations, while Hispanics and others were not significantly different from whites. Blacks (OR 0.56, 95% CI 0.36,0.87) were less likely to engage in all 4 behaviors, while Hispanics and others were not significantly different from whites. There were no significant racial/ethnic differences in fruit and vegetable consumption.
CONCLUSIONS: Few patients engage in multiple self-care behaviors at recommended levels, and there are significant racial/ethnic differences in physical activity, dietary, and foot care behaviors among adults with diabetes.
KEY WORDS: diabetes; racial/ethnic differences; self-care behavior. DOI: 10.1007/s11606-007-0120-9 2007 Society of General Internal Medicine 2007;22:115120
INTRODUCTION
Diabetes is a chronic debilitating condition that is associated with significant morbidity, mortality, and increased health care costs.1 Blacks and Hispanics have higher prevalence of diabetes, are disproportionately burdened with the complications and disability from diabetes,...