Anderson, RM

Brown, A

Brusuelas, RJ

Davison, M

Ettner, S

Funnell, MM

Ganz, D

Mangione, CM

Norris, K

Sarkisian, C

Steers, N

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UCLAUCLA Previously Published WorksTitleRandomized community-based intervention to improve self-management of diabetes among older African Americans and LatinosPermalinkhttps://escholarship.org/uc/item/2cz0n14vAuthorsMangione, CMBrown, ASarkisian, Cet al.Publication Date2007 Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaAmong the 373 women in the older age group (>30 at the time of surgery), blackwomen were significantly more likely to express desire for reversal compared towhite women (aOR: 2.6; 95% CI: 1.2, 5.8). Among the 561 women in the youngerage group (18–30 at the time of surgery), Hispanic and black women were equallylikely to express desire for reversal as white women (aOR: 1.0, 95% CI: 0.6, 1.8;aOR: 1.1, 95% CI: 0.5, 2.2). Insurance status was not a significant predictor ofregret in either of the age strata.CONCLUSIONS: Among women over age 30 at the time of tubal sterilization, blackwomen were much more likely to express desire for reversal than white women.RACIAL AND GENDER DIFFERENCES IN REVASCULARIZATION FOR ACUTECORONARY SYNDROMES. K.M. Freund1; A.K. Jacobs1; J.L. Speckman1; A.Ash1. 1Boston University School of Medicine, Boston, MA. (Tracking ID # 173492)BACKGROUND: Racial and ethnic minority men and women suffer higher mortalityfrom coronary artery disease than white men. It is unknown if mortality differencesreflect differences in disease or differences in treatment. Evaluation and revasculari-zation is the standard of care when feasible in Acute Coronary Syndromes, especiallyfor those at high risk. Our objective is to describe revascularization rates with eithercardiac stent or coronary bypass grafting after Acute Coronary Syndromes by genderand race/ethnicity, adjusted for age, comorbidity,economic status and geographicvariation.METHODS: We conducted logistic regression analyses to assess stent use or coronarybypass grafting, compared with no cardiac intervention in subjects admitted with acutecoronary syndrome. Models controlled for demographics, comorbidities (using claimsdata of inpatient and outpatient visits) and small area geographic variation. The studypopulation was a random sample of 522,389 White, Black and Hispanic Medicarebeneficiaries in 2001, aged 65+ with fee-for-service coverage, and without end stagerenal disease. Blacks and Hispanics were oversampled to be able to study racialdifferences. Results are reported with reweighting to reflect the entire Medicarepopulation.RESULTS: Of the 22,903 admissions with acute coronary syndrome in the sample,34% were black, 25% Hispanic,and 41% were white. In bivariate analyses, Black,Hispanic and White women were less likely to receive either stent or coronary bypassgrafting than their male counterparts, and Whites had higher rates than Black orHispanic subjects (all p<0.001). In multivariate logistic regression adjusted for age,comorbidities, diabetes, prior MI or revascularization, CHF, peripheral arterialdisease, renal insufficiency, CVD, HTN and economic status, Black and Hispanicmen and all women had lower rates of revascularization, compared with their whitecounterparts (Hispanic men OR=0.56 (CI=0.53–0.56) and women 0.75 (0.71–0.80),black men 0.48 (0.47–0.50) and women 0.69 (0.67–0.71). White women (OR=0.67,CI=0.66–0.68), Hispanic women (OR=0.74, CI=0.68–0.80), and Black women(OR=.92, CI=0.88–0.97) had lower rates of revascularization than the correspondingmen.CONCLUSIONS: In the setting of Acute Coronary Syndromes, all women,Hispanics and Blacks are less likely to receive revascularization than white men.Differences in age, economic status and overall health only partially account forthese differences.RACIAL DIFFERENCES IN JOINT REPLACEMENT EXPECTATIONSAMONG VETERANS WITH OSTEOARTHRITIS. P.W. Groeneveld1; C. Kwoh2;M.K. Mor3; M. Geng4; C.J. Appelt4; J.C. Gutierrez5; S.A. Ibrahim4. 1Philadelphia VAMedical Center and the University of Pennsylvania, Philadelphia, PA; 2PittsburghVA Health Care System and University of Pittsburgh, Pittsburgh, PA; 3PittsburghVA Health Care System and The University of Pittsburgh School of Medicine,Pittsburgh, PA; 4Pittsburgh VA Health Care System, Pittsburgh, PA; 5PhiladelphiaVA Medical Center, Philadelphia, PA. (Tracking ID # 172508)BACKGROUND: Joint replacement surgery can dramatically improve the symp-toms and functionality associated with osteoarthritis (OA), yet black and whiteveterans with OA undergo joint replacement surgery at markedly different rates.Patients_ expectations of the outcomes of joint replacement surgery are likely toinfluence their willingness to undergo these elective procedures. There are limiteddata, however, on whether blacks and whites differ in their expectations of jointreplacement outcomes.METHODS: We surveyed 939 veterans (459 blacks, 480 whites) ages 50–79 who wereenrolled in primary care clinics in the VA Pittsburgh Health Care System or thePhiladelphia VA Medical Center between 2004–2006. All enrollees were identified aspotential candidates for joint replacement as indicated by their high scores on theWestern Ontario and McMaster Universities OA Index. The previously validatedHospital for Special Surgery Joint Replacement Expectations Survey (JRES) was usedto assess patients_ expectations for pain relief, functional improvement, andpsychological well-being after surgery. Data were collected in face-to-face interviewswith the respondents. Multivariable linear regression models were fitted to the data toassess the relationship of the JRES score (the dependent variable) to age, race, sex,income, education, employment, marital status, symptoms, functional status, andclinical site.RESULTS: Among hip OA patients (n=296), unadjusted JRES scores among blacks(median=40, interquartile range [IQR]=30–50) were lower than whites_ scores(median=48, IQR=36–60, p<0.001). The adjusted mean score for blacks was 1.3points lower than for whites (p=0.009), and blacks with hip OA were more likelythan whites (adjusted odds ratio [OR]=1.19, p=0.03) to be in the lowestexpectations quartile. Among knee OA patients (n=643), blacks_ unadjusted JRESscores (median=44, IQR=33–56) also were lower than scores for whites (medi-an=49.5, IQR=37–63, p=0.002). The adjusted mean score for blacks was 0.8points lower than for whites (p=0.03), but blacks with knee OA were not morelikely to be in the lowest expectations quartile (p=0.41). Both hip JRES scores (ORfor 1 point increase=1.06, p<0.001) and knee JRES scores (OR for 1 pointincrease=1.04, p<0.001) were strongly associated with patients_ willingness toundergo surgery.CONCLUSIONS: Among potential candidates for joint replacement, black veteranshave significantly more pessimistic expectations for the outcomes of surgery thanwhite veterans. Furthermore, favorable expectations of surgical outcomes werehighly correlated with an increased willingness to consider joint replacement.Together, these findings suggest that interventions designed to enhance minoritypatients_ understanding of the benefits of joint replacement surgery (e.g., testimonialvideos, peer counseling, etc.) may be effective in reducing racial disparities in theseprocedure rates.RANDOMIZED COMMUNITY-BASED INTERVENTION TO IMPROVESELF-MANAGEMENT OF DIABETES AMONG OLDER AFRICAN AMERICANSAND LATINOS. C.M. Mangione1; A. Brown2; C. Sarkisian1; R.J. Brusuelas1;K. Norris3; N. Steers1; M. Davison3; S. Ettner1; D. Ganz1; M.M. Funnell4;R.M. Anderson4. 1University of California, Los Angeles, Los Angeles, CA; 2Universityof California, Los Angeles, Los Angeles, AZ; 3Charles R. Drew University of Medicineand Science, Los Angeles, CA; 4University of Michigan, Ann Arbor, MI. (Tracking ID# 173704)BACKGROUND: Although participation in self-care has been shown to improveglycemic control, many persons with diabetes report low levels of physical activity,self-monitoring of blood glucose (SMBG), or following a special diet. To address thisproblem, we conducted a community-based randomized trial of a behavioralintervention with older Latinos and African Americans designed to enhanceparticipation in diabetes self-care. Our intervention was implemented in English andSpanish, grounded in empowerment theory, and used individualized goal-setting andproblem-solving to effect behavior change.METHODS: From 2004 to 2005, we recruited participants from senior centers,churches, and community clinics who were African American or Latino, English orSpanish speaking, Q 55 years and had hemoglobin A1c Q8%. All Latino groupsessions were conducted in Spanish. We gave each participant a glucose meter andstrips and instruction on their use. Participants were then randomized to either 6weekly diabetes intervention group meetings that were facilitated by a trainedhealth educator or to a 6 weekly control group health lectures unrelated todiabetes. As dictated by empowerment theory, the content of each session wasparticipant driven yet also included strategies for enhancing physical activity, eatinga healthier diet, managing multiple medications, and control of risk factors such asblood pressure, cholesterol, and glycemia. Our primary endpoint was change frombaseline to 6-month follow-up in hemoglobin A1c. We also measured change in anumber of potential mediators such as diabetes knowledge, self-efficacy, andreported participation in self-care and other intermediate outcomes includingsystolic blood pressure (SBP), LDL cholesterol (LDL), and body mass index(BMI).RESULTS: The 258 intervention and 258 control participants were 38% African-American and 62% Latino. Mean age was 63 years, 71% were female, 70% had anincome less than $15,000 per year, 43% were uninsured, and less than half had everhad diabetes education. Six-month follow-up data were available for 223 interventionand 217 control participants. At baseline, mean hemoglobin A1c was 9.6%(intervention) and 9.7% (control), mean (SD) SBP was 141 (20) (intervention) and141 (19) (control), and mean (SD) LDL-cholesterol was 119 (35) (intervention) and120 (37) (control). At follow-up, mean hemoglobin A1c improved by 1.0% for theintervention group and by 0.5% for the controls (p=0.016 between trial arms). Noneof the potential mediators tested improved at follow-up. Additionally, SBP, LDL-Cholesterol, and BMI did not improve in either group.CONCLUSIONS: This simple, community-based, low-cost behavioral interventiondesigned to improve self-care of diabetes among poor, low literacy populations didsignificantly improve glycemic control but did not improve other importantintermediate outcomes associated with risk for complications, such as blood pressureand cholesterol levels. The 0.5% decrease in A1c between trial arms, if sustained overtime, potentially could confer a 15% reduction in end-stage renal disease orprogression to blindness. Easy access to diabetes programs designed to supportpersonal self-management could mitigate long-term complications among some of thehighest risk populations for poor outcomes.RECENT DRUG USE AND HOMELESSNESS ARE ASSOCIATEDWITH INCREASED SHORT-TERM MORTALITY IN HIV-INFECTED PERSONSWITH ALCOHOL PROBLEMS. A.Y. Walley1; D. Cheng1; H. Libman2; D. Nunes1;C.R. Horsburgh1; R. Saitz1; J. Samet1. 1Boston University, Boston, MA; 2HarvardUniversity, Boston, MA. (Tracking ID # 172595)ABSTRACTS158 JGIM

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Randomized community-based intervention to improve self-management of diabetes among older African Americans and Latinos

Randomized community-based intervention to improve self-management of diabetes among older African Americans and Latinos

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