DISPARITIES IN DIABETES AND HYPERTENSION QUALITY DURING THE COVID-19 PANDEMIC

ABSTRACT

BACKGROUND: The COVID-19 pandemic changed ambulatory chronic disease care. Our goal was to assess racial, ethnic, and language disparities in diabetes (DM) and hypertension (HTN) quality during the pandemic. METHODS: Our primary outcomes were rates of DM and HTN control among patients attributed to primary care physicians. We fit linear models, with random effects to account for repeated monthly measures on patients, to estimate the absolute differences between the 2020 and 2019 rates in the same months. The models estimated and compared these monthly differences across race/ethnicity groups (ref White, non-Hispanic), and language groups (ref English-speaking). We adjusted for age, sex, payor, education, and income. Significance was determined from analogous logistic regression models. RESULTS: We included 32,914 patients with DM and 125,478 with HTN. Overall, performance was better in Jan-March 2020 compared to JanMarch 2019, however this differential reversed by June 2020, falling below June 2019 (Figure). Among patients with DM, Asian and Black patients had a larger decrease in control rates compared to White patients. For example, comparing September 2019 to September 2020 the absolute control rates were 12% lower for Asian patients and 14% lower for Black patients compared to 8.3% for White patients (p<0.001). Non-English-speaking patients had a larger decrease in absolute control rates compared to English-speaking patients. For HTN, Asian, Black, and Hispanic patients had larger decreases in absolute control rates compared to White patients. For example, comparing October 2019 to October 2020, control rates decreased by 13.3% for Asian patients, 15.7% for Black patients, and 13.9% for Hispanic patients compared to 10% for White patients (p<0.001). Non-English-speaking patients had a 14.4% decrease in control rates comparing September 2019 to September 2020 while there was a 10.5% decrease among English-speaking patients (p<0.001). CONCLUSIONS: DM and HTN quality disproportionately worsened among marginalized patients during the pandemic.