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UnEqual: Racial Disparities of Diabetes

Thursday, July 23, 2009 at 4:31 AM

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A lot of things increase the likelihood a person will develop diabetes – obesity, a family history, and advancing age. But diabetes is skewed along another line as well -- race. For example, while less than 7 percent of non-Hispanic whites over age 20 have diabetes, nearly 15 percent of African Americans do. As part of ideastream’s week-long examination of one of America’s fastest growing health problems, reporter Gretchen Cuda examines what's behind the racial and ethnic disparities of this disease.

CUDA:  3 times a week, Dorothy Hardgess comes to the dialysis clinic to have a machine do what her damaged kidneys can’t – remove toxins from her blood.  Hardgess’ kidneys were damaged by years of uncontrolled blood sugar –a battle with type 2 diabetes she has waged most of her adult life.  She holds a family photograph and points out the people in her family with diabetes.

HARDGES: My two brothers they had diabetes.  My sister, My other sister ...

CUDA: The number of people in her family alone with diabetes is shocking ... but it’s a story that’s all to familiar to Justino and Antiona Echeverria.

ANTONIA ECHEVERRIA:  Both my mother and my father had diabetes.  We are 16 children in my family, and 6 girls including me are diabetic, and I also have three brothers who are diabetic.
JUSTINO ECHEVERRIA:  I had three aunts, and my mother all died of complications from diabetes…

CUDA:  Hardgess is an African American; the Echeverrias, a married couple, came to Northeast Ohio from Puerto Rico. They are part of the growing pool of racial and ethnic minorities disproportionately affected by diabetes.  Marshall Chin, a physician and professor of medicine at the University of Chicago, specializes in the disparities in of diabetes.

CHIN:  African Americans and Latinos have higher rates of diabetes.  They have poorer control of their diabetes and they have higher rates of complications, such as blindness and kidney failure

CUDA: Minority populations are up to twice as likely to have diabetes than non-Hispanic whites.  But the big question is WHY?  Troy Duster is a Sociologist at New York University.  He says that social and economic factors may play a much bigger role than genes. 

DUSTER:  People in the biomedical field tend to use their own discipline, whether it’s genetics or cell biology when they see, say, cancer rate differences.  When it fact it may well be the case the differences are a function of extraordinary environmental differences.

CUDA: In the case of diabetes – the environmental difference may be whether you have access to a supermarket or a convenience store; a bag of corn puffs may more available, inexpensive or desirable than fresh fruits or vegetables. Compound those elements of food preference and availability in minority communities with the general American culture of excess and couch potato syndrome ….and you have a recipe for obesity---which is one of the strongest predictors of type 2 diabetes.  Leona Cuttler is an endocrinologist specializing in obesity.She says that socioeconomic status can present big hurdles to healthy living.

CUTTLER:  We have large parts of the urban landscape and sometimes rural landscape where people have difficult access to healthy foods and it’s unsafe to walk. 

CUDA:  And there’s one more factor, according to Marshall chin at the University of Chicago:  access to healthcare.  Diabetes is a disease that requires constant management – but a disproportionate number of minorities have little or no regular access to doctors and nutritionists for guidance.

CHIN: There are huge issues with access to care, and for those that do enter the healthcare system we see that the quality of care, or the outcomes that are received by racial minorities are lesser than those of non-hispanic whites.

CUDA:  It’s a concept that certainly resonates with Dorothy Hardgess, the kidney dialysis patient – who raised her three children on food stamps, and often couldn’t afford bus fare.

HARDGESS: Sometimes certain things you need to do to take care of yourself – its takes more money than you get. 

CUDA:  Having the tools to control diabetes is one thing; exercising the personal responsibility to use them is another.  And that, experts say, is one of the greatest challenges for diabetics—no matter what your racial or ethnic background.  Gretchen Cuda, 90.3

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Health, Diabetes: The Constant Shadow

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