Abstract
Purpose
Racial disparities have been shown in outcomes and treatment of children with type
1 diabetes (T1D). The purpose of this study was to examine temporal trends in insulin
pump use among non-Hispanic white (NHW), non-Hispanic black (NHB) and Hispanic children
attending a large urban diabetes center.
.
This study was a retrospective chart review of insulin pump usage by race (NHW/ NHB)
in 2005, and race/ethnicity (NHW/NHB/Hispanic) in 2011–2019. Demographic data (age,
sex, diabetes duration, SES) and most recent hemoglobin A1c were also abstracted in
2011–2019.
Results
In 2005, NHW children were twice as likely to use an insulin pump as NHB children.
From 2011 to 2019, the odds ratio increased to 2.5 for NHW compared to NHB children.
The odds of Hispanic children using insulin pumps were also higher than NHB. Insurance
status (government versus private), a surrogate for SES, had very little influence
on these trends, with NHW children consistently more likely than NHB children to be
treated with insulin pumps in 2011, 2013, 2017, 2019 (p < 0.001).
Conclusions
We have demonstrated that racial disparities in insulin pump use have persisted over
the past 15 years, and are not determined by SES. This inequity in diabetes treatment
may be playing a role in the poorer glycemic control and higher rates of diabetes
complications in NHB children.
Practice implications
Healthcare providers should be cognizant of racial and ethnic disparities in the treatment
of children with T1D. Standardized treatment protocols may reduce unconscious bias
in prescribing.
Keywords
Abbreviations:
CHOP (Children's Hospital of Philadelphia), IQR (Interquartile range), NHB (Non-Hispanic black), NHW (Non-Hispanic white), SES (Socioeconomic status), T1D (Type 1 diabetes)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 01, 2020
Accepted:
August 7,
2020
Received in revised form:
August 6,
2020
Received:
June 12,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
