Racial/Ethnic Differences in Diabetes Care for Older Veterans

BACKGROUND: Veterans Health Administration (VHA) databases are used extensively to study racial/ethnic disparities; however, these databases may not capture all care received by VHA patients. OBJECTIVES: We examined the extent to which accounting for non-VHA care changed conclusions about racial/ethnic disparities for VHA patients with diabetes. METHODS: Using a cross-sectional observational study, we analyzed a national sample of noninstitutionalized Hispanic (n = 5931), black (n = 24,670), and white (n = 149,222) VHA patients with diabetes who were at least 65 years of age for receipt of annual HbA1c testing, low-density lipoprotein (LDL) cholesterol testing, or eye examination from VHA and Medicare administrative files. RESULTS: In VHA alone data, adjusting for patient characteristics, Hispanic and black patients were as likely as white patients to receive HbA1c testing (odds ratio 1.06 95% confidence interval 0.99-1.13 and 1.04 1.00-1.07, respectively), and more likely to receive eye examinations (1.31 1.24-1.38 and 1.33 1.29-1.37, respectively). Hispanic patients were equally likely (1.01 0.95-1.07) and black patients were less likely (0.81 0.79-0.84) to receive LDL testing versus white patients. In VHA plus Medicare data, Hispanic and black patients were less likely than white patients to receive HbA1c (0.76 0.71-0.82 and 0.83 0.80-0.87, respectively) and LDL testing (0.84 0.79-0.90 and 0.70 0.68-0.72, respectively), and equally likely to receive eye examinations (0.91 0.86-0.96) and 0.98 0.95-1.01), respectively). Accounting for VHA facility had little effect on results. CONCLUSIONS: Restricting to VHA data masks racial/ethnic disparities in care of VHA patients. VHA researchers must be aware and supplement VHA data with other sources whenever possible.