type 2 diabetes causes a disproportionate health burden among racial and ethnic minorities in the United States. At the same time, these minority populations are among those most likely to be uninsured or to experience interruptions in healthcare coverage. Lack of insurance is associated with a greater probability of having undiagnosed diabetes, and with poorer quality of care for patients with diagnosed diabetes. As healthcare reform moves toward implementation following the passage of national legislation, important gaps remain in the understanding of the expected population health effects of expanding insurance coverage, and especially regarding the likely impact on health disparities. With respect to diabetes in particular, there is urgent need for a comprehensive analysis that traces the entire pathway from insurance to reduced morbidity and mortality, and provides a unifying framework for previous observational and quasi- experimental studies. The overall goal of this proposed study is to deploy systematic and rigorous empirical analysis to investigate the potential impact of expanding insurance coverage on health disparities in diabetes, at the national and state level. The project has three specific aims: 1) Quantify the potential impact of expanding insurance coverage among diabetic patients, in terms of improvements in key modifiable risk factors (e.g. high blood glucose) associated with major complications of diabetes, by racial and ethnic group. 2) Predict, based on alternative population risk factor distributions reflecting different insurance coverage scenarios, reductions in racial/ethnic disparities in diabetes-related morbidity and mortality attributable to expanded insurance coverage. 3) Evaluate the validity of the model results by comparing predicted and observed outcomes in Massachusetts following the expansion of insurance coverage through the landmark 2006 health reform. Collectively, the proposed research activities will constitute a coherent, significant and innovative advance in addressing critical gaps in policy-relevant information on diabetes disparities that are amenable to improvements through changes in the healthcare system. This information is essential for identifying key priorities and setting realistic targets for reducing health disparities, and for defining critical benchmarks for evaluating progress towards these objectives as major developments in national healthcare policy evolve.
Racial and ethnic minorities in the United States bear a disproportionate health burden from diabetes, and are also most likely to lack continuous health insurance. Lack of insurance is associated with a greater chance of having undiagnosed diabetes, and with poorer quality of care for patients with diagnosed diabetes. As healthcare reform moves toward implementation following the passage of national legislation, this project aims to provide a rigorous, systematic and comprehensive examination of the potential impact of expanding insurance coverage on health disparities in diabetes.
|Danaei, Goodarz; García Rodríguez, Luis Alberto; Cantero, Oscar Fernández et al. (2017) Electronic medical records can be used to emulate target trials of sustained treatment strategies. J Clin Epidemiol :|
|Golozar, Asieh; Khalili, Davood; Etemadi, Arash et al. (2017) White rice intake and incidence of type-2 diabetes: analysis of two prospective cohort studies from Iran. BMC Public Health 17:133|
|Ueda, Peter; Woodward, Mark; Lu, Yuan et al. (2017) Laboratory-based and office-based risk scores and charts to predict 10-year risk of cardiovascular disease in 182 countries: a pooled analysis of prospective cohorts and health surveys. Lancet Diabetes Endocrinol 5:196-213|
|Zack, Rachel M; Irema, Kahema; Kazonda, Patrick et al. (2016) Determinants of high blood pressure and barriers to diagnosis and treatment in Dar es Salaam, Tanzania. J Hypertens 34:2353-2364|
|Lu, Yuan; Ezzati, Majid; Rimm, Eric B et al. (2016) Sick Populations and Sick Subpopulations: Reducing Disparities in Cardiovascular Disease Between Blacks and Whites in the United States. Circulation 134:472-85|
|Danaei, Goodarz; Robins, James M; Young, Jessica G et al. (2016) Weight Loss and Coronary Heart Disease: Sensitivity Analysis for Unmeasured Confounding by Undiagnosed Disease. Epidemiology 27:302-10|
|Hua, Xinyang; Carvalho, Natalie; Tew, Michelle et al. (2016) Expenditures and Prices of Antihyperglycemic Medications in the United States: 2002-2013. JAMA 315:1400-2|
|Lu, Yuan; Hajifathalian, Kaveh; Rimm, Eric B et al. (2016) The Authors Respond. Epidemiology 27:e14-5|
|Suemoto, Claudia K; Lebrao, Maria Lucia; Duarte, Yeda A et al. (2015) Effects of body mass index, abdominal obesity, and type 2 diabetes on mortality in community-dwelling elderly in Sao Paulo, Brazil: analysis of prospective data from the SABE study. J Gerontol A Biol Sci Med Sci 70:503-10|
|Hajifathalian, Kaveh; Ueda, Peter; Lu, Yuan et al. (2015) A novel risk score to predict cardiovascular disease risk in national populations (Globorisk): a pooled analysis of prospective cohorts and health examination surveys. Lancet Diabetes Endocrinol 3:339-55|
Showing the most recent 10 out of 17 publications