ATLANTA — Women with diabetes in the United States frequently are not receiving recommended and needed preventive services.
Women with diabetes who are at the extremes of the life cycle, are poor, and are poorly educated appear to be at the greatest risk for not receiving either diabetes-specific or general preventive care services, according to the findings of a report from the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention.
Data on women aged 18 and older with and without diabetes were obtained from three large nationally representative databases: The Medical Expenditure Panel Survey, 2004; the National Health and Nutrition Examination Survey, 1999-2004; and the National Health Interview Survey, 2005. The report is one of the few such documents to examine any women's health issue by age across the lifespan, Michelle D. Owens-Gary, Ph.D., said at the annual meeting of the American Association of Diabetes Educators.
Although the data are a few years old, they still represent the current situation, coauthor Dr. Gloria L.A. Beckles said in an interview.
“The notion that this is any different in 2009 than in 2004 is a myth. Things change very slowly in chronic disease delivery of care, which depends on the organization of systems. It's not just going to change overnight,” said Dr. Beckles, an epidemiologist, who works with Dr. Owens-Gary, a behavioral psychologist, at the CDC's Division of Diabetes Translation, Atlanta.
Overall, 92% of 1,276 women with diabetes surveyed in 2004 reported having received a hemoglobin A1c measurement in the past year. However, there was a gradient with age, with older women having the greatest likelihood of an HbA1c test and the youngest having the lowest. The proportions for those aged 18-44 years, 45-64, and 65 and older were 84%, 91%, and 96%, respectively. The youngest adult women “could be a vulnerable population we need to pay more attention to,” Dr. Owens-Gary noted.
Compared with HbA1c testing, the proportions of diabetic women receiving recommended annual retinal eye exams and foot exams were far lower. In all, 67% of 1,595 respondents reported having had a retinal exam in the past year. By age group, the proportions were 47%, 66%, and 75%, respectively, for those aged 18-44, 45-64, and 65-plus. Foot exams were somewhat more frequent, with 70% of 1,556 total reporting having received one in the past year, and 61%, 74%, and 69%, respectively, from the youngest group to the oldest.
Receipt of all three diabetes-specific preventive care services was less than 50% for all age groups: 45% of a total 1,430 respondents, and just 30% of the 18- to 44-year-old group, 49% of the 45-64 group and 47% of those aged 65 years and older. There were no significant ethnic differences in receipt of the three recommended services. In women of all ethnic origins, the percentage receiving all three recommended preventive care services was low, ranging from 41% (Hispanic, all races) to 51% (non-Hispanic, African American).
By family income, the women who were poor or near-poor were less likely than were those with diabetes from households with high income to have received all three services, ranging from 38% for the lowest quartile to 57% for the highest, she said.
For Pap tests and mammograms, there were no significant differences across the life stages for women with and without diabetes: 71% of 1,336 with diabetes and 79% of 14,967 without reported having a Pap smear within the past 3 years. Among women over 40, 66.5% of 6,829 with diabetes and 66.8% of 8,887 without reported having a mammogram in the past 2 years. There was no significant difference for receipt of Pap test or mammogram by race/ethnic group.
The proportion of women over 50 who had ever received a colonoscopy, sigmoidoscopy, or proctoscopy did not differ between 1,031 with diabetes (48.5%) and 6,041 without (48.4%). However, younger women were less likely to receive them than were older women, and Hispanic women with diabetes were less likely than were white or African American women with diabetes to be screened for colon cancer. Women with less than a high school education and those with the lowest family incomes also were less likely to receive Pap smears, mammograms, or colonoscopies, she reported.
Women with diabetes were more likely than were those without to have received an influenza vaccination in the past 12 months (50% vs. 22%). However, the rate is still low considering that all persons with diabetes are recommended to receive annual flu shots. And younger women with diabetes were far less likely than were those older to be immunized, with just 33% of those aged 18-44 receiving the shot, compared with 43% of those aged 45-64 and 65% of those aged 65 and above. Hispanic women with diabetes had the lowest rate of all racial/ethnic groups, at 39%, compared with 55% of whites. And again there was a gradient by family income, ranging from 42% for the lowest quartile to 55% for the highest.