Black youths more at risk for diabetic deaths

Late diagnosis, lack of access to health care blamed

Young African-Americans with Type 1 diabetes are nine times more likely to die of complications of the disease than whites, say University of Illinois researchers.

In addition, the death rate of black diabetics under 25 was three times higher than the general black population, while white youngsters were no more likely to die than their non-diabetic peers.

Young blacks may be diagnosed later than whites because physicians dismiss the likelihood of Type 1 diabetes in blacks. The disease is somewhat less common than in whites, says Rebecca Lipton, BSN, MPH, PhD, a research fellow at the University of Illinois at Chicago School of Public Health and lead author of the study published in the May 5 issue of Pediatrics.

"They think of blacks as having Type 2 diabetes, so they don’t look closely enough at the youngsters and consider the possibility of Type 1," Lipton explains. "But what many of us may not realize is that diabetes is the second-most common chronic disease among black youngsters after asthma."

Lipton says the number of cases is small, with an overall mortality rate for Type 1 diabetes in Chicago at 247.2 deaths per 100,000 cases. But the numbers are telling when they are separated by race. The death rates were 447.8 per 100,000 in blacks, 175.6 in Hispanics, and only 48.2 in whites.

Late diagnosis most likely costs young black patients a great deal in terms of preventing mortality and complications, Lipton says, noting that of 23 black patients who died, seven occurred at or near the time of diagnosis.

At the same time, of those who died, the average time between diagnosis and death was 7.1 years.

She adds that end stage renal disease, which was the primary cause of death in four of the total 30 deaths in all races, was found by searching death certificates, medical records, and U.S. Census data in Chicago from 1987 through 1994. All four patients who died of renal failure were black.

"It may be argued that virtually all the deaths recorded in this study could have been prevented by adequate preventive care or by proper emergency interventions," Lipton wrote. "Since metabolic decompensation is relatively easy to recognize in young people, and appropriate treatment for IDDM usually can be delivered in a clinic or hospital emergency department setting . . . inadequacies in clinical care are suspected generally when death occurs from acute IDDM complications."

Economic deprivation common in racial minorities seems to contribute to the death rate among young black diabetics, says Lipton, because they lack access to the kind of health care that will result in an early diagnosis and prevent complications.

"Socioeconomic deprivation is the most obvious answer to me," she says. "Blacks have no genetic predisposition to dying more frequently than whites."

Lack of insurance fuels noncompliance

Lack of insurance is certainly a major factor in the death rate among young blacks, Lipton says.

"All kids with diabetes who don’t have other insurance should be eligible for Medicaid, but even that’s not enough," she says. "In Chicago, many kids get excellent care at clinics, but they are kicked off Medicaid when they are 18 and can’t pay for their medications. Unless they’re girls and get pregnant or they are alcoholics or drug abusers and can get in federal programs, they’re out of luck."

There are few, if any, insurance plans, including Medicaid that pay for test strips, for example, Lipton says, and the cost of test strips for a diabetic testing three or four times a day is about $75 a month.

Worse yet, young diabetics who reach the age of 18 without insurance are likely to fall into noncompliance because of the high cost of supplies. At $22 a 1,000-unit vial for insulin and $22 per 100 syringes, in addition to the cost of test strips — plus medical office visits and quarterly labs at a cost of about $200 per quarter — the cost of compliance is beyond the means of many. At a minimum total cost approaching $200 a month, it’s a given that many young people cannot afford the medical care and medicines they need to survive, Lipton says.

"These deaths shouldn’t happen at all," she concludes.

Robert Goldstein, MD, PhD, vice president for research at the Juvenile Diabetes Foundation in New York City, agrees.

Yet, he says, "If there was perfect equivalent care, we could probably make [this discrepancy] go away. If I looked at 50 people in the ghetto and 50 people in the suburbs, I’d probably find the same thing — so it’s not necessarily racial, but it is socioeconomic."

Goldstein criticizes the methodology of Lipton’s study because it is retrospective and relies on notoriously inaccurate medical records and death certificates.

But, he says, the take-home message to health care professionals is clear: "Let’s get on the stick here and pay attention to the possibility that young black kids can have Type 1 diabetes, too."

[Contact Rebecca Lipton at 312-996-0064.]