Health disparities between people with disabilities and those without are poorly understood and under-researched. Factors that impact healthcare outcomes for disabled individuals include socioeconomic and environmental influences on healthcare system accessibility and quality of care.
Our study demonstrates disabilities like visual impairments intersect with race to influence the management of chronic conditions like diabetes. By examining disparities in the accessibility and quality of healthcare and subsequent health outcomes, this research illuminates the complex ways disability and race interact within healthcare systems.
The study leverages data from the TriNetX Research Network, encompassing electronic medical records from approximately 115 million patients across 83 de-identified healthcare organizations.
1️⃣ Patients with visual impairment will have higher HbA1c and a higher rate of CKD(chronic kidney disease) regardless of race.
2️⃣ Patients with visual impairment will be less likely to have received the recommended standards of care for diabetes patients.
3️⃣ The disparities between those with visual impairment and those without these conditions, as identified in hypotheses 1 and 2, will be greater among racial minorities.
Cohort | Race | Patient Count | Mean Age | % Female | % with Diabetes | % with Diabetes-Related Ophthalmic Complications |
---|---|---|---|---|---|---|
No VDRC | AA or Black | 1,524,072 | 64 | 61% | 31% | 4% |
White | 9,954,167 | 67 | 57% | 20% | 2% | |
Asian | 456,630 | 65 | 61% | 23% | 3% | |
VDRC Present | AA or Black | 22,768 | 68 | 55% | 58% | 23% |
White | 105,287 | 72 | 54% | 46% | 12% | |
Asian | 3,243 | 70 | 56% | 47% | 17% |
Race | (-) VDRC, % | (+) VDRC, % | Δ proportion (p-value) | CKD Risk Ratio (p-value) | Uncontrolled Diabetes Risk Ratio (p-value) |
---|---|---|---|---|---|
AA or Black | 70.33% | 81.15% | 10.82% (<0.01) | 1.786 (<0.01) | 0.968 (0.5) |
White | 71.84% | 81.03% | 9.19% (<0.01) | 2.274 (<0.01) | 0.843 (<0.01) |
Asian | 63.50% | 75.22% | 11.72% (<0.01) | 1.284 (0.08) | 0.847 (0.36) |
Race | (-) VDRC, % | (+) VDRC, % | Δ proportion (p-value) | CKD Risk Ratio (p-value) | Uncontrolled Diabetes Risk Ratio (p-value) |
---|---|---|---|---|---|
AA or Black | 27.66% | 28.09% | 0.43% (0.55) | 1.807 (<0.01) | 1.106 (0.08) |
White | 30.39% | 24.95% | 5.44% (<0.01) | 2.3 (<0.01) | 1.108 (0.01) |
Asian | 32.42% | 28.90% | 3.52% (0.09) | 1.38 (0.02) | 0.909 (0.67) |
Race | (-) VDRC, % | (+) VDRC, % | Δ proportion (p-value) | CKD Risk Ratio (p-value) | Uncontrolled Diabetes Risk Ratio (p-value) |
---|---|---|---|---|---|
AA or Black | 60.20% | 64.82% | 4.62% (<0.01) | 1.751 (<0.01) | 0.979 (0.67) |
White | 53.07% | 51.49% | 1.58% (<0.01) | 2.203 (<0.01) | 0.9 (<0.01) |
Asian | 57.41% | 58.53% | 1.12% (0.63) | 1.242 (0.04) | 0.989 (0.95) |
This section presents a comorbidity analysis by race, visualizing the prevalence and distribution of key comorbidities among patients with diabetes. The charts below show the comorbidity profiles for African American/Black, White, and Asian populations in the study cohort.
Result:
Patients with visual impairment will have higher HbA1c and a higher rate of CKD(chronic kidney disease) regardless of race.
Result: There was a mixed result regarding HbA1c levels, but had a consistent result for CKD where individuals with a visual impairment had a higher risk of CKD across all racial groups.
Patients with visual impairment will be less likely to have received the recommended standards of care for diabetes patients.
Result: Individuals with visual impairment had more ambulatory visits, but white people with visual impairment were less likely to have recommended HbA1c testing and the GFR had a mixed result, meaning that the study partially supports the hypothesis that people with visual impairment are less likely to receive recommended standards of care, and the differences in access depend on the type of care and the race of the patient.
The disparities between those with visual impairment and those without these conditions, as identified in hypotheses 1 and 2, will be greater among racial minorities.
Result: While disparities exist, they do not consistently show that racial minorities have greater disparities compared to the White population, suggesting that the study does indicate that there is an interaction between race and visual impairment in determining the quality of care and health outcomes, but in more complex way.