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Health Equity. 2019 Sep 23;3(1):472-479. doi: 10.1089/heq.2019.0071. eCollection 2019.

Racial-Geographic Disparity in Lipid Management in Veterans with Type 2 Diabetes: A 10-Year Retrospective Cohort Study.

Author information

1
Department of Health Professions, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
2
Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
3
Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina.
4
Department of SCCP Clinical Pharmacy and Outcome Sciences-MUSC Campus, College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina.
5
Department of Surgery and College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
6
Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.

Abstract

Purpose: The prevalence of diabetes in U.S. veterans (20.5%) is nearly three times that of the general population. Minority veterans have higher rates of diabetes compared with their counterparts and urban/rural residence is also associated with uncontrolled cholesterol. However, the interplay between urban/rural residence and race/ethnicity on cholesterol control is unclear. Methods: Veterans Health Administration Corporate Data Warehouse and Centers for Medicare and Medicaid data were used to create unique dataset and perform longitudinal study of veterans with type 2 diabetes from 2006 to 2016. Logistic regression was used to model the association between low-density lipoprotein (LDL) control and the primary exposures (race/ethnicity and location of residence) after adjusting for all measured covariates, including the interaction between location of residence and race/ethnicity. Results: There was a significant interaction between race/ethnicity and rural residence. Rural non-Hispanic Black (NHB) veterans had higher odds for LDL >100 mg/dL (odds ratio [OR]=1.70, 95% confidence interval [CI] 1.50-1.60) and for LDL >70 mg/dL (OR=1.59, 95% CI 1.53-1.64) compared with urban non-Hispanic White (NHW) veterans. Similarly, compared with urban NHW, urban NHB veterans had higher odds of LDL >100 mg/dL (OR=1.45, 95% CI 1.43-1.47) and LDL >70 mg/dL (OR=1.36, 95% CI 1.34-1.38). Conclusion: This study highlights health disparities for veterans with type 2 diabetes. Future research is needed to evaluate interventions for mitigating these disparities in cholesterol management among veterans with diabetes.

KEYWORDS:

diabetes; disparities; race/ethnicity; rural residence; veterans

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