The goal of this study was to determine whether African-American Medicare beneficiaries with diabetes are at special risk for poor health, sub-optimal preventive care, and high national expenditures. Data were derived from patient interviews conducted among Medicare beneficiaries who were aged 65 years or older in 1993 and who had diabetes.

African Americans and whites with diabetes had a similar number of comorbidities and diabetic complications; however, African Americans had worse health perception. The rates for quality of care, which included receipt of regular laboratory tests and preventive procedures and visits to an ophthalmologist, were low. In general, African Americans were less likely than whites to have these procedures (both in univariate analyses and after controlling for gender, age, and education). Race differences with regard to these variables were particularly potent among women, the elderly (at least 85 years), and those with less than a high school education

African Americans had higher reimbursements for the use of home health services, skilled nursing facilities, outpatient services, medicines, and "other physician." With regard to overall resource utilization, total reimbursement was slightly higher for African Americans, but after adjusting for age, sex, education, and measures of health status, race was not statistically significantly associated with reimbursement (p=0.09). While their average number of visits to a physician per year was significantly lower, American Americans were more likely to make emergency visits than whites. There was no racial difference in “having a health problem that warranted a physician visit, but not seeking care” (15% of African Americans versus 9% of white reported this, p=0.15). However, compared with whites, African Americans were less likely to be "very satisfied with the ease of getting to a doctor from where they lived" (p=0.06).

The authors point out that even though older African Americans were less likely than whites to receive processes associated with reduced morbidity in younger patients, their rates of diabetic complication were similar. The similar complication rates may reflect a weaker linkage between these processes of care and outcome in older patients than among younger patients. Thus, the results of this study indicate that the most appropriate measures of high quality care for older people are unclear.

The authors conclude that "these [racial] discrepancies [in receiving several recommended services] may reflect a preference by African Americans to avoid medical testing and procedures, but they could also result from a less aggressive treatment style by physicians toward African Americans, or difficulty by African Americans in gaining access to the health care system".