Racial/ethnic disparities exist for both poor ABC measures (A1C > 9%, blood pressure (BP) >= 160/100 mmHg, and non-HDL cholesterol >= 160 mg/dL) and access to care or utilization measures (health insurance coverage, having >= 4 doctor visits in past year, and having a routine place of health care) among U.S. adults with diabetes. Using 2011-2018 National Health and Nutrition Examination Survey, we examined the associations between health care access/utilization and racial/ethnic disparities in poor ABC measures. We estimated the marginal effect of race/ethnicity on each ABC measure by each access-to-care/utilization measure, respectively, using weighted multivariate logistic regressions. Poor ABC measures were more prevalent in non-Hispanic Black (NHB) (A1C: 19%, BP:13%, non-HDL cholesterol: 22%) and Hispanic (25%, 9%, 34%) than non-Hispanic White (NHW) (11%, 7%, 21%) people. Similar disparities were observed for poor access to care/utilization: NHB (uninsured:11%, <4 visits:38%, no routine place for care:4%) , Hispanic (23%, 44%, 11%) , NHW (6%, 34%, 4%) . Effects of access to care/utilization on poor ABC measures varied by measures of both access-to-care/utilization and ABC control. Compared with NHW, having no insurance vs. having insurance was much more likely to be associated with poor A1C level in NHB (16% vs. 5%, p < 0.05) and Hispanic populations (26% vs. 7%, p < 0.01) . However, insurance status was not associated with racial/ethnic disparities on poor BP and cholesterol measures. Having >= 4 doctor visits in the past year and a routine place for care were not associated with racial/ethnic disparities of any poor ABC measures. Closing the insurance coverage gap by increasing insured rate among racial/ethnic minorities could help reduce the racial/ethnic disparity in A1C level. Future studies to explore reasons why other access-to-care/utilization measures were not associated with racial/ethnic disparities in poor ABC measures may be beneficial.


S.Tang: None. P.Zhang: None.

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