November 14 is World Diabetes Day, and November is American Diabetes Month.
During the global coronavirus pandemic, racial and ethnic minorities with diabetes and multiple chronic conditions had a difficult time accessing routine care. John M. Clements, assistant professor of public health in the College of Human Medicine, looks at three time periods during the pandemic to better understand trends in care, inform an equitable public health response, and improve access to care.
According to the International Diabetes Federation, approximately 537 million adults worldwide were living with diabetes, with 6.7 million deaths worldwide attributed to diabetes in 2021. Diabetes is one of the top 10 leading causes of death in the United States.
During the first year of the COVID-19 pandemic in the U.S., the mortality rate from diabetes rose by about 13.8%, while in the State of Michigan, the mortality rate rose by 18.5%, an increase higher than any other chronic disease that is a leading cause of death.
Some of my previous research shows that over 30% of Medicare beneficiaries that are over 65 in the State of Michigan have type 2 diabetes. But most people with diabetes never have diabetes alone. My research focuses on multiple chronic conditions (MCC), and I consider the leading chronic causes of death in people with diabetes and how these combinations of illnesses affect outcomes.
I found that there are disparities in access to care measures in people with combinations of chronic diseases compared to people with diabetes alone. In addition, racial and ethnic minorities experience:
- higher risk for having more chronic conditions
- lower risk of accessing primary care prevention services
- higher risk of using the emergency department
- greater costs for inpatient care
In an article published in The Journal of Diabetes and its Complications, I used data from COVID-19 Supplements of Medicare Current Beneficiary Surveys administered in the summer and fall of 2020 and winter of 2021. I found that from March 2020 through March 2021 (reflecting the first year of the pandemic in the U.S.) Medicare beneficiaries with diabetes plus various MCC combinations report being unable to get necessary medical care compared to beneficiaries with diabetes alone.
Many hospitals and physician offices closed early in the pandemic, and many people could not get needed medical care. However, even after physician offices opened again, some beneficiaries were still unable to get care a year later. For instance, beneficiaries with diabetes plus cancer or diabetes plus cancer/stroke reported higher rates of being unable to access care than those with diabetes alone. At the one-year mark, beneficiaries with diabetes plus COPD, diabetes plus stroke, or diabetes plus Alzheimer’s reported higher rates of being unable to get treatment for an ongoing condition. Finally, beneficiaries with diabetes plus Alzheimer’s reported higher rates of being unable to get a regular check-up 12 months into the pandemic.
Members of racial/ethnic minority groups reported higher rates of being unable to obtain services at various times during the pandemic compared to non-Hispanic Whites. Non-Hispanic Blacks and Hispanics continued to experience these higher rates 12 months into the global pandemic.
The inability to access care may explain the significant increase in diabetes mortality in the first year of the pandemic. This research provides evidence that the systems in place continue to disadvantage certain groups in the U.S. and that work remains for providers and public health systems to dismantle and reimagine systems that ultimately provide equitable access to care.
John M. Clements, PhD, is a quantitative sociologist by training with an additional specialization in environmental science and policy. His recent research focuses on health outcomes and disparities in people with diabetes and multiple chronic conditions. He is currently working to shed light on how COVID-19 influenced the course of disease for people with diabetes, focusing on disparities in outcomes that are related to race and combinations of chronic disease, as well as how rural experiences shape disease progression and access to care.
November 14, 2022