Diabetes Health and Disability Pathways: Racial/Ethnic, Socioeconomic, and Gender Disparities.

Abstract

This dissertation examines how race/ethnicity, socioeconomic status, and gender relate to longitudinal health outcomes among older adults with type 2 diabetes. Further, this dissertation analyzes the extent to which certain factors, such as social ties and health and illness behaviors, mediate this relationship. The outcomes examined are self-reported health status, adherence, and functional limitations. The hypotheses tested are that individuals with less social support—as well as individuals from socially disadvantaged backgrounds—will report lower health status and greater functional limitations relative to individuals from socially privileged backgrounds and relative to individuals greater amounts of social support.

Longitudinal survey data is examined from the Health and Retirement Study (HRS) along with the 2003 HRS Diabetes Supplement. Further, qualitative and quantitative data were collected and analyzed from a small sample (30) of community-dwelling seniors. Multi-level modeling and mixed-method analysis is used to examine individual-level patterns of change.

Throughout this series of analyses, race/ethnicity, socioeconomic status, and gender were independent predictors of subsequent health and disability outcomes. However, additional characteristics, such as social support and health characteristics, are important mediators of this relationship. As discussed in the second chapter, diabetic support is not significantly associated with health decline, but it is strongly associated with adherence to health-promoting activities consisting of a diabetic regimen. Therefore, the extent to which one receives illness support for a given regimen component is highly positively associated with adhering to that component, although this adherence does not necessarily translate into protection against perceived decline in health. As discussed in the fourth chapter, however, different forms of social support interact strongly with health behaviors to prevent functional decline.

As diabetes and other chronic illnesses are increasingly recognized as social and public health priorities, it will become more critical to identify proximal and distal mechanisms by which chronic illness trajectories differ. No previous studies have adequately addressed this aim as proposed in this research. The identification of divergent pathways (and in particular, the relationship to mechanisms that can be altered in interventions) over the life course can enable more effective and efficient prevention practices and interventions.