With so much data being gathered during the pandemic, COVID-19 research has revealed the glaring severity of healthcare inequities in non-white populations.

“We’re seeing even higher rates of health inequities in COVID-19,” explains Nicole Rioles, Director of Clinical Partnerships and Population Health at T1D Exchange.

T1D Exchange’s “T1D & COVID-19 Surveillance Study” inadvertently collected significant evidence of health inequities from data gathered at over 50 sites across the country.

“Our study highlights significant differences in acute adverse outcomes between Black and Hispanic patients diagnosed with type 1 diabetes and COVID-19 as compared to White patients,” Osagie Ebekozien, MD, MPH, Vice President of Population Health and Quality Improvement at T1D Exchange and Assistant Professor of Population Health at University of Mississippi Medical Center, told Healio in 2021.

Notable data highlighting significant health inequity within the diabetes population includes:

  • Non-Hispanic White patients had a lower median A1c at baseline (8.3%) compared to non-Hispanic Black (11.7%) and Hispanic (8.9%) patients.
  • Non-Hispanic White patients were more likely to be on CGM and/or insulin pumps than non-Hispanic Black or Hispanic patients, and also be on private insurance.
  • Non-Hispanic Black and Hispanic patients were significantly more likely to present with DKA following COVID-19 (61% and 24% of cases, respectively) compared to non-Hispanic White patients (7%).
  • When data was adjusted for age, A1c, sex, and insurance type (public or private), the association between DKA and non-Hispanic Black or Hispanic identity became even stronger.
  • Non-Hispanic Black and Hispanic patients were also more likely to be hospitalized (68% and 40% of cases, respectively) than non-Hispanic White patients (19% of cases).

While the data speaks for itself, the bigger question is: what can be done about it?

Creating the T1D Exchange Health Equity Advancement Lab (HEAL) Program

“The HEAL program is a work in progress that will bring the best of population health science, quality improvement and health equity,” explains Ori Odugbesan, Manager of Quality Improvement and Population Health at the T1D Exchange. The program’s vision is to achieve equity for patients with type 1 diabetes by piloting innovative approaches in the T1D Exchange Quality Improvement Collaborative.

Gathering data goes far beyond simply assessing a person’s health and noting their race or ethnicity. Health outcomes are never the result of just one or two variables.

Instead, HEAL will begin by collecting data on details such as safe housing, education level, employment status, literacy, ability to understand medical documents, access to health insurance, access to transportation, access to food, and much more.

What are “health inequities” vs. “health disparities”?

  • A health disparity: “I am less likely to have dementia at age 30 than someone who is age 70.”
  • A health inequity: “I am less likely to receive in-depth diabetes education to help me achieve an HbA1c of 7.0 as a black woman compared to a White woman.”

An inequity is something that is unjust, unequal, avoidable, and unnecessary. Unlike the 70-year-old being more at-risk of developing dementia than a 30-year-old, improving the diabetes management education for a Black woman to be equal to that of a White woman is attainable.

Disparities & Unconscious Biases in Healthcare

Past studies observing how healthcare professionals care for patients based on their skin color have uncovered marked biases based on skin color.

“This research found that there’s an unconscious bias, demonstrated even by the way a doctor holds a clipboard as an accidental barrier between themselves and the patient, creating a barrier to care,” explains Rioles.

Part of the HEAL program will focus on deeper training for frontline staff to help increase awareness of these unconscious biases and differences in how they might be communicating with white patients versus non-white patients.

But the root of the problem runs deeper than how patients are cared for.

“Addressing disparities in healthcare is one thing, but it’s the whole system, and it starts with the leadership of a hospital, for example, and encouraging them to change their hiring practices and set goals to overcome common inequities.”

The T1D Exchange HEAL program will also focus on addressing biases within the leadership of any given healthcare facility because the hiring practices have a significant impact on the care practices.

Reducing Inequities in Diabetes Technology

Another example of an equity project under the HEAL program is an industry-sponsored project to reduce inequities in prescription rates and uptake for Continuous Glucose Monitors and Insulin Pump among four centers in the Quality Improvement Collaborative.

Click here to read our “Breaking Down the Science” series and learn more about advancing health equity in T1D, including the 10-step framework developed by the T1D Exchange Quality Improvement Collaborative to address the literature gap on practical ways health care providers can address inequities.

Click here to listen to a panel discussion on Health Inequities in T1D care from the T1D Exchange that further highlights the importance of the T1D Exchange HEAL program.