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Do Doctors Contribute to the Social Patterning of Disease?

McKinlay JB, Marceau, LD, Piccolo, RJ.
Medical Care Research and Review
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Abstract

Data from the Boston Area Community Health Survey show that both undiagnosed signs and symptoms and diagnosed type 2 diabetes mellitus (T2DM) are patterned by socioeconomic status (SES). Such patterning is corroborated by National Health and Nutrition Examination Survey data for diagnosed T2DM. Complementary data from an experiment concerning clinical decision making show T2DM is patterned by race/ethnicity, following diagnosis by a physician. Undiagnosed signs and symptoms of T2DM in the community are patterned by SES (rather than race/ethnicity), but following diagnosis by primary care physicians they are patterned more by race/ethnicity (rather than by SES). Race/ethnicity and SES in the United States are almost totally confounded, such that measuring one is essentially also measuring the other. Physician patterning of T2DM by race/ethnicity, however, motivates the search for genetic and biophysiologic explanations and distracts attention from the more important contribution of SES circumstances to the prevalence of diabetes mellitus.

Diagnosed and Undiagnosed Diabetes by Race/Ethnicity AND SES


This figure displays the distribution of total diabetes by race/ethnicity, adding socioeconomic status (SES). The large difference between SES groups is evident in all three race/ethnic groups. A separate analysis of National Health and Nutrition Survey (NHANES) data produces a patterning by SES identical to that displayed here – corroborating the results from BACH. (Race/ethnicity chi-square: for lower SES: p=0.650; for middle SES: p=0.096; for upper SES: p<0.001)

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Heretic's Corner
10/4/2011 - Posted by NERI Upstream
For example, how useful is it to encourage households in poverty (experiencing food insecurity) to consume more costly “healthful” diets (lean meats, whole grains and fresh vegetables and fruit). The examples are endless............