Educational Disparities in Diabetes Complications

糖尿病并发症的教育差异

基本信息

批准号：
6805535
负责人：
Andrew John Karter
金额：
$ 37.45万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2003
资助国家：
美国
起止时间：
2003-09-26 至 2007-07-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): The broad, long-term objective of this proposal is to evaluate the role of education in the incidence of diabetic complications, in a large, well-characterized population, within an integrated, managed care setting Kaiser Permanente (KP). This study will take advantage of a cohort begun in 1994 of approximately 78,000 survey respondents (83% response rate) for whom self-reported educational attainment data was collected. Using the survey date as baseline, follow-up data (up to 14 years) will be collected on mediating variables and the following outcomes: incident complications, including myocardial infarction, stroke, congestive heart failure, end-stage renal disease, lower-extremity amputation, proliferative retinopathy, acute metabolic events, costs and death. Second, a new survey will be conducted in a stratified random sample of approximately l 5,000 type 2 diabetic patients, ages 50-75, with equal representation of African American, Caucasian and Latinos. This new survey will provide a rich source of data on education and potentially modifiable factors that explain the link between education and complications of diabetes. Primary aims include collaborating with other RFA grantees to evaluate different measures of education; estimating the educational gradient in complications; evaluating modifiable factors that mediate the educational gradient (e.g., health behaviors, diabetes knowledge, psychosocial factors); and differentiating the direct effects of education from those mediated through income. Secondary aims include evaluating the following: ethnic differences in the educational gradient; perceptions regarding barriers to care; the impact of education on patient-provider relationships and adherence; whether rates of referral to specialty care differ by educational attainment; and educational differences in health care costs. Our preliminary studies showed that less educated diabetic patients were in poorer health, had poorer self-care skills, underutilized specialty care, but had higher complication rates, were more likely to be hospitalized or to be seen in the ER, and incurred greater health care costs. Uniform health coverage in this study population avoids residual confounding common to population-based samples, which often suffer from inadequate adjustment for disparities in health care access and/or quality. Modifiable factors that mediate the pathway between education and complications pose candidate targets for interventions aiming to reduce educational disparities. A focus on diabetic complications is particularly compelling given observations of a substantial education differential in health care costs and the existence of efficacious interventions for modifying behavioral and clinical risk factors.

描述（由申请人提供）：该提案的广泛，长期目标是评估教育在糖尿病并发症发生率中的作用，在大型，良好的人群中，在综合的，托管的护理环境Kaiser Permanente（KP）中。这项研究将利用1994年开始的一座队列，大约有78,000名受访者（83％的回应率）为他们收集了自我报告的教育程度数据。使用调查日期作为基线，将在介导变量和以下结果上收集随访数据（最多14年）：事件并发症，包括心肌梗塞，中风，充血性心力衰竭，终末期肾脏疾病，下肢体截肢，增殖性视网膜疗法，急性视网膜疗法，急性代谢事件和死亡。其次，将在大约5,000名2型2型糖尿病患者的分层随机样本中进行新的调查，年龄在50-75岁之间，对非裔美国人，高加索人和拉丁美洲人的同样表示。这项新调查将提供有关教育和潜在可修改因素的丰富数据来源，这些数据解释了教育与糖尿病并发症之间的联系。主要目的包括与其他RFA授予者合作以评估不同的教育措施；估计并发症中的教育梯度；评估介导教育梯度的可修改因素（例如，健康行为，糖尿病知识，社会心理因素）；并将教育的直接影响与通过收入进行的调解的影响区分开来。次要目的包括评估以下内容：教育梯度的种族差异；对护理障碍的看法；教育对患者支持者的关系和依从性的影响；转诊对专业护理的率是否因教育程度有所不同；以及医疗费用的教育差异。我们的初步研究表明，受过教育的糖尿病患者的健康状况较差，自我护理技能较差，专业护理不足，但并发症发生率较高，更有可能在ER中住院或在ER中看到，并且会产生更高的医疗保健费用。在这项研究中，统一的健康覆盖范围避免了基于人群的样本常见的残留混淆，这些样本通常无法调整医疗保健获取和/或质量的差异。可修改的因素介导教育和并发症之间的途径构成候选目标，以减少教育差异。鉴于观察到对医疗保健成本的实质性教育差异的观察以及有效的干预措施来改变行为和临床危险因素，因此对糖尿病并发症的重点尤其令人信服。