Racial and Ethnic Variation in Access to Health Care, Provision of Health Care Services, and Ratings of Health Among Women With Histories of Gestational Diabetes Mellitus

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Abstract
OBJECTIVE—The purpose of this study was to assess racial/ethnic variation in access to health care, use of particular health care services, presence of cardiovascular risk factors, and perceptions of health and impairment among women at risk for type 2 diabetes because of their histories of gestational diabetes mellitus (hGDM). RESEARCH DESIGN AND METHODS—We performed a cross-sectional study using the 2001–2003 Behavioral Risk Factor Surveillance System, a national population-based, random sample telephone survey. We assessed access to health care, use of family planning, measurement and elevation of cholesterol, elevation of blood pressure, and respondents’ perceptions of health and impairment among women aged 18–44 years with hGDM (n = 4,718). Multivariate models adjusted for sociodemographic characteristics, BMI, presence of children in the household, and current smoking. RESULTS—Outcome measures were suboptimal across racial/ethnic groups. Approximately one-fifth of the overall population reported no health insurance, cost barriers to physician visits, and no primary care provider. One-quarter had no examination within the past year, and almost one-fifth reported no family planning and elevated cholesterol levels. Latinas were the most disadvantaged, with 40% reporting no health insurance and no primary care provider and one-fourth reporting suboptimal perceptions of health. Asian/Pacific Islanders were the most advantaged in terms of health care access, cholesterol and blood pressure elevation, and impaired physical health. Racial/ethnic differences in health care use and presence of risk factors were not entirely explained by health care access or other covariates. CONCLUSIONS—Significant racial/ethnic variation exists among women with hGDM for access to and use of health care, presence of risk factors, and perceptions of health.