Is Ethnicity An Independent Determinant Of Compliance?

Mechanisms for Racial and Ethnic Disparities in Glycemic Control in Middle-aged and Older Americans in the Health and Retirement Study
Michele Heisler, MD, MPA; Jessica D. Faul, MPH; Rodney A. Hayward, MD; Kenneth M. Langa, MD, PhD; Caroline Blaum, MD, MPH; David Weir, PhD. Arch Intern Med. 2007;167:1853-1860.

The Study

The researchers sent surveys to 1901 respondents 55 years or older with diabetes mellitus, 1233 of whom completed valid at-home hemoglobin A1c (HbA1c) kits. Multivariate regression models were used to examine racial/ethnic differences in HbA1c control and to explore the association of HbA1c level with sociodemographic and clinical factors, access to and quality of diabetes health care, and self-management behaviors and attitudes.

Results and Conclusions, excerpted from the abstract, follow:

Commentary

The pertinence of this study vis-a-vis patient compliance is its support for race as an independent determinant of adherence. Unfortunately, it is difficult and perhaps impossible to assess the significance of its conclusions because of the many other studies that show that race has no impact on compliance and the somewhat lesser number of other studies that indicate that race is a mild, moderate, or major influence on compliance.

And the complexity increases exponentially when race as an interactive factor is considered. For example, studies have looked at - and come to different conclusions regarding - the effect on compliance of racial differences or similarities of patient and doctor. The possibilities seem endless: it’s possible, for example, that variations exist between, say, Whites and Asians but not between Asians and Blacks; perhaps race is a more significant compliance factor in societies rife with racial conflict than in communities characterized by interracial harmony; race could be important in determining adherence for certain specific treatments or disorders but not others; … .

The improbability of controlling for so many confounding factors, alone or in combination, as well as the many conflicting studies about the importance of demographics like ethnicity should make one leery of basing clinical practices on this study’s finding that racial differences in compliance are significant. It is, in fact, difficult to imagine a practical, affordable scheme for investigating potential racial differences in compliance that would provide results that could be confidently used in clinical practice.

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