Diabetes Cases Among Minorities Present Major Challenges for Smaller Cities of New York State, Finds UAlbany CEMHD Report
Contact: Catherine Herman (518) 956-8150
ALBANY, N.Y. (September 15, 2006) -- The rates of diabetes-related hospitalizations among blacks and the degree of disparity in relation to whites are on par in major upstate cities to what is found in New York City, according the University at Albany's Center for the Elimination of Minority Health Disparities (CEMHD) in a new report. The study, The Quiet Crisis: Minority-Majority Disparities for Diabetes in Upstate New York Cities finds that the rates of hospitalization for blacks living in most upstate cities are typically as high or higher than they are for New York City. The hospitalization rates of blacks exceed the rates for whites by substantial margins in every location.
The report follows up on a New York Times series earlier this year that called attention to the epidemic of diabetes in New York City's minority communities. That epidemic appears to be occurring in the African-American communities in other New York cities. In reaching this conclusion, the report considers four types of diagnoses that lead to hospitalization for persons with diabetes: short-term diabetes complications such as coma and ketoacidosis; long-term complications, which involve kidney, visual and neurological complications due to poorly controlled diabetes; uncontrolled diabetes; and lower-extremity amputations due to diabetes. The report relies on hospitalization records because diabetes is not reported by physicians to the state health department and because many individuals with diabetes are unaware of their condition; consequently, there is no simple, direct way to measure diabetes prevalence in the general population.
The rates of diabetes-related hospitalization among Hispanics vary quite widely across the state, and so does the disparity in relation to whites. For instance, for short-term diabetes complications, the Hispanic hospitalization rates in upstate cities are mostly higher than is true in New York City, but because white rates also tend to be higher upstate, the degree of disparity between Hispanics and whites is frequently lower outside of New York City. For long-term diabetes complications, the Hispanic rates are mostly lower upstate than in New York City, and so is the degree of disparity with whites. The researchers conclude that several factors may hold responsibility for the fluctuation, such as higher rates of recent immigration to upstate cities, the reluctance of undocumented immigrants to call attention to themselves and their medical problems, or ethnic "underreporting" by health providers.
"These possible explanations suggest that the rates of hospitalization in this report underestimate the prevalence of diabetes and the problems of primary care in upstate Hispanic communities," said David Strogatz, chair of the Department of Epidemiology and Biostatistics at the University at Albany School of Public Health and a co-author of the report.
"For the minority populations upstate, the disparities revealed in this report demonstrate that the epidemic of diabetes is not confined to the largest cities and metropolitan regions, where the extreme problems of residential segregation and poverty might be thought to contribute to the higher incidence of this disease," added Richard Alba, the other co-author, who is also a Distinguished Professor of Sociology at the University at Albany. "In general diabetes is as much a problem in the smaller cities of the state as it is in the largest cities."
Among the findings:
- No matter what diagnosis is
considered, hospitalization for
diabetes is substantially higher
for blacks in every major city
than for whites (New York City,
Buffalo, Rochester, Syracuse,
Albany, Niagara Falls,
Utica, Troy, Binghamton,
Middletown, Kingston). Depending
on the diagnosis and the city,
the black rate is between
one-and-a-half and eight times
higher than the corresponding
- For Hispanics, the most consistent disparities are observed upstate for short-term diabetes complications. For most upstate cities and especially for those with the largest Hispanic concentrations (Rochester, Buffalo, Syracuse, and Middletown, by number of Hispanics), Hispanic hospitalization rates are higher than in New York City and higher than is true for whites. In the upstate cities with the most Hispanics, the disparity in relation to whites is often as high as that observed for New York City. The pattern for this diagnosis is very significant because urgent medical events, such as coma, are often involved and thus immigrants are unable to avoid hospitalization.
As an NIH EXPORT (Excellence in Partnerships for Community Outreach, Research on Health Disparities and Training) center, UAlbany's Center for the Elimination of Minority Health Disparities will identify health problems and seek ways to reduce and eventually eliminate, minority health inequities by building the University's health disparities research capacity and by strengthening community partners' ability to collaborate on research and intervention programs. Under the direction of Lawrence Schell, professor of anthropology and epidemiology at the University at Albany, CEMHD seeks to make a significant difference in the health of our communities by facilitating university-community partnerships to determine local causes of health disparities and then to determine the best, most community-relevant solutions. For more information, visit CEMHD.