Racial, Ethnic, and Economic Disparities in California Medicare Fee-for-Service. Diabetes. Selected indicators from:

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1 Racial, Ethnic, and Economic Disparities in California Medicare Fee-for-Service Diabetes Selected indicators from: Medicare Fee-For-Service n California: Disparities in Quality by Place, Race and Economic Status California HealthCare Foundation and CMRI

2 African Americans and Hispanics have higher incidence of complications and mortality from diabetes. African Americans have more complications of diabetes than the average Californian and are 84 percent more likely to die from them. Hispanics are 34 percent more likely than to die of diabetes complications than the average Californian.

3 Diabetes complications among African Americans are higher than the California average. End Stage Renal Disease (ESDR) Prevalence, % 6% African Americans Calif ornia 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% Lower Extremity Amputation (LEA) Rates/1,000 Population, % 3.5% African Americans Calif ornia 0.0% 1.0% 2.0% 3.0% 4.0%

4 African American deaths from complications of diabetes are highest among major illnesses. 90% 84% 80% 70% Breast cancer Worse 60% 50% 40% 30% 34% 35% 33% Colorectal Cancer Diabetes AMI CHF Pneumonia / Influenza 20% Stroke CA Average = 0% 10% 0% 5% 1% 0.5% % Relative Difference A negative percentage rate indicates a lower mortality rate than the California average.

5 Diabetes Complication Rates for Hispanics End Stage Renal Disease (ESRD) Prevalence, % 3.8% Hispanics California 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% Lower Extremity Amputation (LEA) Rates/1,000 Population, % 2.9% Hispanics California 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5%

6 Hispanic deaths from complications of diabetes higher than average, lower than other illnesses. 40% 32% Worse CA Average = 0% 30% 20% 10% 0% Breast cancer Colorectal Cancer Diabetes -10% AMI -20% CHF Better -30% -40% -50% -60% -49% -43% -27% -40% -30% -34% Pneumonia / Influenza Stroke % Relative Difference A negative percentage rate indicates a lower mortality rate than the California average.

7 Quality Indicators for Diabetes Preventive Care In 1998, the Centers for Medicare and Medicaid Services (CMS) organized the Diabetes Quality Improvement Project (DQIP) which developed and implemented a set of standardized uniform performance measures for diabetes care. CMS selected 3 of the DQIP measures that could be collected from Medicare billing data to monitor diabetes care among fee-for-service Medicare beneficiaries in every state. 1. A1C (a lab test that indicates the average blood sugar over the past 2-3 months) tested annually 2. Eye examination performed biennially 3. Lipid profile performed biennially

8 California performs relatively well delivering preventive diabetes care. Diabetes care, in at least one of the three quality indicators, was above the national average for all of California s race/ethnic group beneficiaries Rates of Diabetes care are only slightly lower for African Americans and Hispanics Rates of Diabetes care are also only slightly lower for Medicare recipients with low SES

9 Diabetes care is slightly worse for non-white beneficiaries. Better CA average = 0% 4% 2% 0% 3% Worse -2% -4% -6% -2% -5% Caucasian Asian African American Hispanic -8% Native American -10% -9% % relative difference -12% -14% -12%

10 Diabetes Care for Patients with Low Socio-economic Status Better CA Average = 0% 0% -1% -2% Worse -3% -4% -5% -6% -7% -8% -9% % Relative Difference -4% -7% -8% -6% Dual Eligible Undereducated Area Impoverished Area Hispanic Area

11 Diabetes care much better than other preventive services for recipients with low SES. Better CA Average = 0% 0% -5% -10% -4% -7% -6% -8% -15% Dual Eligible Worse -20% -25% -30% -19% -25% -29% -29% -29% -29% -18% -20% -22% Undereducated Area Impoverished Area Hispanic Area -35% -33% -33% -40% Breast Cancer Colorectal Cancer -37% Outpatient Immunization Diabetes

12 Questions for Further Study Why are complication and death rates higher for African Americans and Hispanics, despite comparable preventive care? What is the most effective strategy to reduce complication and death rates for African Americans and Hispanics from diabetes? Would higher intensity diabetes prevention services targeted to at risk African Americans and Hispanic recipients reduce mortality and complication rates? Would a diabetes awareness and early detection campaign be more effective than a prevention program aimed at those already diagnosed?