Diabetes numeracy: an overlooked factor in understanding racial disparities in glycemic control.

Osborn CY, Cavanaugh K, Wallston KA, White RO, Rothman RL
Diabetes Care. 2009 32 (9): 1614-9

PMID: 19401443 · PMCID: PMC2732142 · DOI:10.2337/dc09-0425

OBJECTIVE - Understanding the reasons and eliminating the pervasive health disparities in diabetes is a major research, clinical, and health policy goal. We examined whether health literacy, general numeracy, and diabetes-related numeracy explain the association between African American race and poor glycemic control (A1C) in patients with diabetes.

RESEARCH DESIGN AND METHODS - Adults with type 2 diabetes (n = 383) were enrolled in a cross-sectional study at primary care and diabetes clinics at three medical centers. Data collected included the following: self-reported race, health literacy, general numeracy, diabetes-related numeracy, A1C, and sociodemographic factors. A series of structural equation models were estimated to explore the interrelations between variables and test for mediation.

RESULTS - In model 1, younger age (r = -0.21, P < 0.001), insulin use (r = 0.27, P < 0.001), greater years with diabetes (r = 0.16, P < 0.01), and African American race (r = 0.12, P < 0.01) were all associated with poorer glycemic control. In model 2, diabetes-related numeracy emerged as a strong predictor of A1C (r = -0.46, P < 0.001), reducing the association between African American and poor glycemic control to nonsignificance (r = 0.10, NS). In model 3, African American race and older age were associated with lower diabetes-related numeracy; younger age, insulin use, more years with diabetes, and lower diabetes-related numeracy were associated with poor glycemic control.

CONCLUSIONS - Diabetes-related numeracy reduced the explanatory power of African American race, such that low diabetes-related numeracy, not African American race, was significantly related to poor glycemic control. Interventions that address numeracy could help to reduce racial disparities in diabetes.

MeSH Terms (16)

Adolescent Adult African Continental Ancestry Group Aged Aged, 80 and over Age Factors Blood Glucose Cross-Sectional Studies Diabetes Mellitus Female Humans Male Middle Aged Sex Factors Socioeconomic Factors Young Adult

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