{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T06:08:01Z","timestamp":1779084481749,"version":"3.51.4"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009873","name":"Claremont Graduate University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009873","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Clin. Diabetes Healthc."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Compared to non-Hispanic White adults, racial\/ethnic minority adults have a higher risk of developing diabetes and its complications. Proper use of healthcare services is important for reducing the prevalence of diabetes and the risk of complications. However, minority populations tend to receive a lower quality of healthcare service and have greater barriers to diabetes self-management. This study aims to determine racial\/ethnic disparities in the utilization of diabetes-related healthcare services and estimate factors that are associated with the utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study used the 2016\u20132021 Behavioral Risk Factor Surveillance System data. Accomplishment of diabetes-related healthcare services (annual clinical care, self-care) among patients with diabetes and diabetes screening rates among adults at risk of developing diabetes were assessed. Chi-square tests explored associations between race\/ethnicity and healthcare service use. Weighted logistic regression models estimated factors independently associated with utilization, controlling for covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with diabetes who reported fully completing annual clinical care exams were less than 50% for all racial and ethnic groups. Asian American patients reported the lowest percentage of fully completing self-care practices (1.2%). Compared to non-Hispanic White patients, Hispanic and Latino patients had the lowest odds of fully completing all annual exams (OR\u00a0=\u00a00.10, 95% CI, 0.07, 0.14) and self-care practices (OR\u00a0=\u00a00.63, 95% CI, 0.43, 0.92). Except for non-Hispanic Black adults, asymptomatic adults at risk from other racial and ethnic minority groups had significantly lower odds of having screening, and Asian American adults had the lowest odds of screening uptake (OR\u00a0=\u00a00.55, 95% CI, 0.52, 0.59) compared to non-Hispanic White adults. Healthcare insurance coverage, access to healthcare, self-rated general health status, and alcohol consumption were significantly associated with diabetes-related healthcare utilization status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Racial and ethnic disparities exist in diabetes-related healthcare service utilization. These findings underscore an urgent need to improve diabetes-related healthcare service use for racial and ethnic minority groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcdhc.2026.1675970","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T05:44:35Z","timestamp":1779083075000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Racial and ethnic disparities in diabetes-related healthcare service use"],"prefix":"10.3389","volume":"7","author":[{"given":"Gaole","family":"Song","sequence":"first","affiliation":[{"name":"Department of Population Sciences, Beckman Research Institute, City of Hope National Medical Center","place":["Duarte, CA, United States"]},{"name":"School of Community & Global Health, Claremont Graduate University","place":["Claremont, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. Anderson","family":"Johnson","sequence":"additional","affiliation":[{"name":"School of Community & Global Health, Claremont Graduate University","place":["Claremont, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-Chin","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Psychological Science, Claremont McKenna College","place":["Claremont, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yawen","family":"Li","sequence":"additional","affiliation":[{"name":"School of Social Work, California State University","place":["San Bernardino, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Xie","sequence":"additional","affiliation":[{"name":"School of Community & Global Health, Claremont Graduate University","place":["Claremont, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"B1","unstructured":"Diabetes"},{"key":"B2","unstructured":"Diabetes Basics\n          \n          2023"},{"key":"B3","unstructured":"National Diabetes Statistics Report, 2020"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-020-01369-x","article-title":"Diabetes complications in racial and ethnic minority populations in the USA","volume":"21","author":"Haw","year":"2021","journal-title":"Curr Diabetes Rep"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2389","DOI":"10.1001\/jama.2019.19365","article-title":"Prevalence of diabetes by race and ethnicity in the United States, 2011-2016","volume":"322","author":"Cheng","year":"2019","journal-title":"JAMA"},{"key":"B6","unstructured":"Diabetes Research, Education, Advocacy"},{"key":"B7","doi-asserted-by":"crossref","unstructured":"Cowie\n              CC\n            \n          \n          Diabetes diagnosis and control: Missed opportunities to improve health : The 2018 Kelly West Award Lecture, American Diabetes Association\n          \n          2019","DOI":"10.2337\/dci18-0047"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcd.2018.04.005","article-title":"Are the U.S. territories lagging behind in diabetes care practices","volume":"12","author":"Ogilvie","year":"2018","journal-title":"Primary Care Diabetes"},{"key":"B9","unstructured":"Lower your risk of diabetes complications"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1186\/1478-7954-8-29","article-title":"Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence","volume":"8","author":"Boyle","year":"2010","journal-title":"Popul Health Metr"},{"key":"B11","unstructured":"About BRFSS\n          \n          2014"},{"key":"B12","unstructured":"Behavioral Risk Factor Surveillance System Overview 2020"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.2337\/dc26-S002","article-title":"Diagnosis and classification of diabetes: Standards of care in diabetes\u20142026","volume":"49","year":"2026","journal-title":"Diabetes Care"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-016-3913-x","article-title":"Racial and ethnic disparities in diabetes screening between Asian Americans and other adults: BRFSS 2012\u20132014","volume":"32","author":"Tung","year":"2016","journal-title":"J Gen Internal Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0125249","article-title":"Receipt of glucose testing and performance of two US diabetes screening guidelines, 2007-2012","volume":"10","author":"Bullard","year":"2015","journal-title":"PloS One"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.12531","article-title":"Screening for prediabetes and type 2 diabetes: US Preventive Services Task Force recommendation statement","volume":"326","year":"2021","journal-title":"JAMA"},{"key":"B17","unstructured":"Exempt research. 45 CFR \u00a746.104(d)(4)(iv)"},{"key":"B18","unstructured":"The Behavioral Risk Factor Surveillance System (BRFSS)\n          \n          2023"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2307\/2137284","article-title":"Revisiting the behavioral model and access to medical care: does it matter","volume":"36","author":"Andersen","year":"1995","journal-title":"J Health Soc Behav"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12705","article-title":"Racial\/ethnic and gender disparities in health care use and access","volume":"53","author":"Manuel","year":"2018","journal-title":"Health Serv Res"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.2337\/dc19-0532","article-title":"Racial\/ethnic disparities in the prevalence of diabetes and prediabetes by BMI: Patient Outcomes Research To Advance Learning (PORTAL) Multisite Cohort of Adults in the U.S","volume":"42","author":"Zhu","year":"2019","journal-title":"Diabetes Care"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1177\/0145721714552501","article-title":"Differences in diabetes self-care activities by race\/ethnicity and insulin use","volume":"40","author":"Johnson","year":"2014","journal-title":"Diabetes Educator"},{"key":"B23","article-title":"Diabetes retinopathy and related health management in Asians versus whites using BRFSS 2005\u20132017 data","volume":"11","author":"Yan","year":"2019","journal-title":"Int J Physiol Pathophysiol Pharmacol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.5888\/pcd14.170023","article-title":"Participation in a diabetes self-management class among adults with diabetes, New Jersey 2013\u20132015","volume":"14","author":"Santorelli","year":"2017","journal-title":"Preventing Chronic Dis"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.5888\/pcd15.180250","article-title":"Diabetes quality of care and maintenance in New England: Can cross-state collaboration move us forward","volume":"15","author":"Dumont","year":"2018","journal-title":"Preventing Chronic Dis"},{"key":"B26","volume-title":"Applied Survey Data Analysis","author":"Heeringa","year":"2017"},{"key":"B27","unstructured":"Complex Sampling Weights and Preparing 2022 BRFSS Module Data for Analysis\n          \n          2023"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1177\/1090198115579416","article-title":"Racial\/ethnic differences in use of health care services for diabetes management","volume":"42","author":"Chandler","year":"2015","journal-title":"Health Educ Behav"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.24926\/iip.v10i4.2064","article-title":"Trends and disparities in quality of diabetes care in the US: The National Health and Nutrition Examination Survey, 1999-2016","volume":"10","author":"Kamat","year":"2019","journal-title":"Innov Pharm"},{"key":"B30","doi-asserted-by":"publisher","first-page":"107026","DOI":"10.1016\/j.yebeh.2020.107026","article-title":"Health literacy and education level correlates of participation and outcome in a remotely delivered epilepsy self-management program","volume":"107","author":"Sudhakar","year":"2020","journal-title":"Epilepsy Behav"},{"key":"B31","doi-asserted-by":"publisher","first-page":"127","DOI":"10.4103\/jehp.jehp_65_18","article-title":"Investigating the effect of education on health literacy and its relation to health-promoting behaviors in health center","volume":"7","author":"Bayati","year":"2018","journal-title":"J Educ Health Promot"},{"key":"B32","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1186\/s12913-018-3197-4","article-title":"The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study","volume":"18","author":"Jansen","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2022.104803","article-title":"Educational attainment and willingness to use technology for health and to share health information \u2013 The reimagining healthcare survey","volume":"164","author":"Lee","year":"2022","journal-title":"Int J Med Inf"},{"key":"B34","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1080\/07370016.2018.1404832","article-title":"Barriers to health care access for low income families: a review of literature","volume":"35","author":"Lazar","year":"2018","journal-title":"J Community Health Nurs"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2020.00231","article-title":"Socioeconomic status and access to healthcare: interrelated drivers for healthy aging","volume":"8","author":"McMaughan","year":"2020","journal-title":"Front Public Health"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17103495","article-title":"Why people do not attend health screenings: factors that influence willingness to participate in health screenings for chronic diseases","volume":"17","author":"Chien","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16091645","article-title":"Primary drivers of willingness to continue to participate in community-based health screening for chronic diseases","volume":"16","author":"Chien","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-2391","article-title":"BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening","volume":"38","author":"Hsu","year":"2015","journal-title":"Diabetes Care"},{"key":"B39","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1089\/heq.2019.0087","article-title":"Cultural influences on dietary self-management of type 2 diabetes in East Asian Americans: a mixed-methods systematic review","volume":"4","author":"Li-Geng","year":"2020","journal-title":"Health Equity"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.2337\/dc22-0594","article-title":"Impact of limited English proficiency on the diagnosis and awareness of diabetes: The National Health and Nutrition Examination Survey, 2003-2018","volume":"45","author":"Holman","year":"2022","journal-title":"Diabetes Care"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-0722","article-title":"Elevated rates of diabetes in Pacific Islanders and Asian subgroups: The Diabetes Study of Northern California (DISTANCE)","volume":"36","author":"Karter","year":"2013","journal-title":"Diabetes Care"},{"key":"B42","doi-asserted-by":"publisher","first-page":"34","DOI":"10.20431\/2455-5983.0301005","article-title":"Diabetes self-management behaviors among American Indians in the Midwestern United States","volume":"3","author":"Daley","year":"2017","journal-title":"ARC J Diabetes Endocrinol"},{"key":"B43","unstructured":"Improving Health in INDIAn Country. Diabetes"},{"key":"B44","article-title":"Fact Sheets","volume-title":"Special Diabetes Program for Indians","year":"2013"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S384974","article-title":"A culturally tailored diabetes self-management intervention incorporating race-congruent peer support to address beliefs, medication adherence and diabetes control in African Americans: A pilot feasibility study","volume":"16","author":"Shiyanbola","year":"2022","journal-title":"Patient Prefer Adherence"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1177\/0145721708323642","article-title":"Culturally tailored intervention for rural African Americans with type 2 diabetes","volume":"34","author":"Utz","year":"2008","journal-title":"Diabetes Educ"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980021003682","article-title":"Culturally tailored lifestyle interventions for the prevention and management of type 2 diabetes in adults of Black African ancestry: a systematic review of tailoring methods and their effectiveness","volume":"25","author":"Wadi","year":"2022","journal-title":"Public Health Nutr"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2025.112195","article-title":"Changes in diabetes screening and exercise during the COVID-19 pandemic in adults with prediabetes","volume":"224","author":"Rodriguez","year":"2025","journal-title":"Diabetes Res Clin Pract"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjd.2022.09.037","article-title":"Changes to diabetes screening during the early waves of the COVID-19 pandemic","volume":"46","author":"Fazli","year":"2022","journal-title":"Can J Diabetes"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.2337\/cd21-0136","article-title":"Impact of the COVID-19 pandemic on diabetes care among a North Carolina patient population","volume":"40","author":"Bancks","year":"2022","journal-title":"Clin Diabetes"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.2337\/dci17-0025","article-title":"2017 national standards for diabetes self-management education and support","volume":"40","author":"Beck","year":"2017","journal-title":"Diabetes Care"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0217771","article-title":"Enablers and barriers to effective diabetes self-management: A multi-national investigation","volume":"14","author":"Adu","year":"2019","journal-title":"PloS One"}],"container-title":["Frontiers in Clinical Diabetes and Healthcare"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcdhc.2026.1675970\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T05:44:38Z","timestamp":1779083078000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcdhc.2026.1675970\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":52,"alternative-id":["10.3389\/fcdhc.2026.1675970"],"URL":"https:\/\/doi.org\/10.3389\/fcdhc.2026.1675970","relation":{},"ISSN":["2673-6616"],"issn-type":[{"value":"2673-6616","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]},"article-number":"1675970"}}