Prevalence of and disparities in barriers to care experienced by youth with type 1 diabetes
Jessica M Valenzuela, Michael Seid, Beth Waitzfelder, Andrea M Anderson, Daniel P Beavers, Dana M Dabelea, Lawrence M Dolan, Giuseppina Imperatore, Santica Marcovina, Kristi Reynolds, Joyce Yi-Frazier, Elizabeth J Mayer-Davis, SEARCH for Diabetes in Youth Study Group, Jean M Lawrence, Kristi Reynolds, Mary Helen Black, Harpreet S Takhar, Kim Holmquist, Jin-Wen Hsu, David J Pettitt, Dana Dabelea, Richard F Hamman, Lisa Testaverde, Georgeanna J Klingensmith, Marian J Rewers, David Maahs, Paul Wadwa, Stephen Daniels, Kristen Nadeau, Clifford A Bloch, Carmelita Sorrelman, Jeffrey Powell, Susie John, Kathy Love-Osborne, Carol Greenlee, Beatriz L Rodriguez, Wilfred Fujimoto, David Curb, Fiona Kennedy, Greg Uramoto, Sorrell Waxman, Richard Chung, Beth Waitzfelder, Teresa Hillier, Lawrence M Dolan, Michael Seid, Elaine Urbina, Amy Shah, Debra A Standiford, Elizabeth J Mayer-Davis, Joan Thomas, Angela D Liese, Robert R Moran, Gladys Gaillard-McBride, Lisa Knight, Deborah Bowlby, James Amrhein, Bryce Nelson, Pam Clark, Mark Parker, Catherine Pihoker, Maryam Afkarian, Irl Hirsch, Lenna L Liu, John Neff, Joyce Yi-Frazier, Beth Loots, Patricia D'Alessandro, Jessica Fosse, Sue Kearns, Mary Klingsheim, Katherine Cochrane, Michael Pascual, Connor Mitrovich, Carla Greenbaum, Giuseppina Imperatore, Desmond E Williams, Henry S Kahn, Bernice Moore, Gregg W Edward, Sharon H Saydah, Barbara Linder, Santica M Marcovina, Vinod P Gaur, Jessica Harting, Ronny Bell, Ralph D'Agostino, Jasmin Divers, Wei Lang, Timothy Morgan, Michelle Naughton, Leora Henkin, Gena Hargis, Maureen T Goldstein, Jeanette Andrews, Nora Fitzgerald, Scott Isom, Jennifer Talton, Jessica M Valenzuela, Michael Seid, Beth Waitzfelder, Andrea M Anderson, Daniel P Beavers, Dana M Dabelea, Lawrence M Dolan, Giuseppina Imperatore, Santica Marcovina, Kristi Reynolds, Joyce Yi-Frazier, Elizabeth J Mayer-Davis, SEARCH for Diabetes in Youth Study Group, Jean M Lawrence, Kristi Reynolds, Mary Helen Black, Harpreet S Takhar, Kim Holmquist, Jin-Wen Hsu, David J Pettitt, Dana Dabelea, Richard F Hamman, Lisa Testaverde, Georgeanna J Klingensmith, Marian J Rewers, David Maahs, Paul Wadwa, Stephen Daniels, Kristen Nadeau, Clifford A Bloch, Carmelita Sorrelman, Jeffrey Powell, Susie John, Kathy Love-Osborne, Carol Greenlee, Beatriz L Rodriguez, Wilfred Fujimoto, David Curb, Fiona Kennedy, Greg Uramoto, Sorrell Waxman, Richard Chung, Beth Waitzfelder, Teresa Hillier, Lawrence M Dolan, Michael Seid, Elaine Urbina, Amy Shah, Debra A Standiford, Elizabeth J Mayer-Davis, Joan Thomas, Angela D Liese, Robert R Moran, Gladys Gaillard-McBride, Lisa Knight, Deborah Bowlby, James Amrhein, Bryce Nelson, Pam Clark, Mark Parker, Catherine Pihoker, Maryam Afkarian, Irl Hirsch, Lenna L Liu, John Neff, Joyce Yi-Frazier, Beth Loots, Patricia D'Alessandro, Jessica Fosse, Sue Kearns, Mary Klingsheim, Katherine Cochrane, Michael Pascual, Connor Mitrovich, Carla Greenbaum, Giuseppina Imperatore, Desmond E Williams, Henry S Kahn, Bernice Moore, Gregg W Edward, Sharon H Saydah, Barbara Linder, Santica M Marcovina, Vinod P Gaur, Jessica Harting, Ronny Bell, Ralph D'Agostino, Jasmin Divers, Wei Lang, Timothy Morgan, Michelle Naughton, Leora Henkin, Gena Hargis, Maureen T Goldstein, Jeanette Andrews, Nora Fitzgerald, Scott Isom, Jennifer Talton
Abstract
Objective: To describe the prevalence of access and process barriers to health care and to examine their relationship to sociodemographic and disease factors in a large and diverse cohort of US youth with type 1 diabetes.
Study design: A cross-sectional analysis of 780 youth who participated in the SEARCH for Diabetes in Youth Study and were diagnosed with type 1 diabetes in 2002-2005. Experience of barriers to care was collected from parent report on questionnaires. Analyses included multivariate regression models to predict the presence of specific barriers to care.
Results: Overall, 81.7% of participants reported at least one barrier; the 3 most common were costs (47.5%), communication (43.0%), and getting needed information (48.4%). Problems with access to care, not having a regular provider, and receiving contextual care (care that takes into account personal and family context) were associated with poorer glycated hemoglobin levels. Adjusted multivariate models indicated that barriers related to access (regular provider, cost) were most likely for youth with low family income and those without public health insurance. Barriers associated with the processes of quality care (contextual care, communication) were more likely for Hispanic youth and those whose parents had less education.
Conclusions: This study indicates that a large proportion of youth with type 1 diabetes experience substantial barriers to care. Barriers to access and those associated with processes of quality care differed by sociodemographic characteristics. Future investigators should expand knowledge of the systemic processes that lead to disparate outcomes for some youth with diabetes and assess potential solutions.
Copyright © 2014 Elsevier Inc. All rights reserved.
Source: PubMed