Pilot 3
Emily Nicklett MSW PhD-C
Email: enicklet@umich.edu 
Emily Nicklett is a candidate joint doctoral program Sociology & Health Services Organization and Policy. Originally from Hockinson, Washington, Ms. Nicklett came to Michigan after completing her MSW at Columbia University in New York. In diverse work settings (such as a New York City public hospital and an Indian Reservation in southern Arizona), Ms. Nicklett developed a strong interest in health disparities. At UM, working with faculty mentors Jersey Liang and Renee Anspach, she developed the research interest of examining health disparities among older adults. For her dissertation, she will examine (using mixed methods) disparities in trajectories of diabetes outcomes by racial/ethnic, socioeconomic, and gender. Also interested in mental health (and working with Daniel Eisenberg's Healthy Minds Study), Ms. Nicklett hopes to examine, from a life-course perspective, the co-occurrence of physical and mental chronic illness. She hopes, upon completion of her joint program, to conduct research in the field of social gerontology and life-course studies.
ABSTRACT
Examining the role of sociodemographic characteristics in diabetic experience and outcomes
(E. Nicklett PI)
(1-year pilot)
Diabetes mellitus and its complications continue to be a national health concern, particularly among socially disadvantaged populations. However, research lacks consensus regarding the factors that contribute to the differential impact of diabetes on population groups over time. Within this framework, more research is needed to identify mechanisms through which disparities develop and compound. The overarching aim of the proposed research is to fill this gap by increasing the understanding of why individuals from socially disadvantaged populations report worse diabetic outcomes as they age, as well to as gain insight into the mechanisms underlying these disparities. Specifically, this research will identify the diverse pathways through which this chronic illness unfolds. This proposed research has three specific aims: To examine disparities—and the processes that underlie them—in diabetic outcomes by race/ethnicity, socioeconomic position, and gender. The outcomes examined among individuals with type 2 diabetes mellitus will be self-reported health status, functional limitations, and the onset of complications associated with type 2 diabetes mellitus. We will control for factors such as regimen adherence, medical care, and health behaviors (e.g., physical activity, diet). We hypothesize that, even while controlling for these factors, individuals from socially disadvantaged backgrounds (non-Whites, those of lower socioeconomic position, and women) will independently and disproportionately carry the burden of diabetes—they will report lower health status, more functional limitations, and a greater number of co-morbidities than privileged groups.
Specific Aim #1: To examine the extent to which there are disparities in the outcomes of diabetes later in life by race/ethnicity, we will document the trajectories of several health status measures (subjective well-being, functional limitations, and the onset of complications associated with type 2 diabetes mellitus among three different groups: non-Hispanic whites, non-Hispanic African Americans, and Hispanics. We hypothesize that, relative to non-Hispanic whites, both non-Hispanic African Americans and Hispanics will experience a more rapid decline of health status and onset of diabetes-associated complications and limitations, as well as experiencing earlier mortality. We hypothesize that these disparities are due to cumulative socio-economic disadvantage as well as racial/ethnic discrimination.
- Specific Aim #2: To examine the extent to which there are disparities in the outcomes of diabetes later in life by socioeconomic position, we will analyze the dynamic trajectories of health measures by different measures of SEP, including childhood socioeconomic circumstances, level of education, occupational status, and income/wealth attainment. We hypothesize that those from relatively lower-status socioeconomic groups will experience sharper decline in well-being and earlier mortality than those from relatively higher-status socioeconomic groups. We hypothesize that these disparities can be attributed to both proximal (health insurance, cost of medications, availability of adherence-maximizing equipment and facilities) and distal (stress, health-detrimental life events) sources.
- Specific Aim #3: To examine the extent to which there are disparities in the outcomes of diabetes later in life by gender, we will document the same health-related measures over time by gender. As consistent with previous literature, we hypothesize that diabetic women will experience a sharper rate of health decline than diabetic men, although the rate of decline among both sexes interacts with social characteristics of interest (relationship status and provision or receipt of informal care)
To accomplish these specific aims, qualitative and quantitative data will be collected and analyzed from a small sample (30) of community-dwelling seniors. This pilot study data will be triangulated with longitudinal survey data on diabetic individuals from the eight-wave Health and Retirement Study (HRS) along with the 2003 HRS Diabetes Supplement. As diabetes and other chronic illnesses are increasingly recognized as social and public health priorities, it will become more crucial to identify proximal and distal mechanisms that cause chronic illness trajectories to diverge for advantaged and disadvantaged persons, to prevent the exacerbation of health disparities. No previous studies have adequately addressed this aim in the way we have proposed. The identification of group-specific points of divergence can enable more effective and efficient prevention practices and interventions.