Discrimination and Type 2 Diabetes-Related Health Outcomes among Hispanic Adults in the United States: An Integrative Literature Review

Abstract

Type 2 diabetes mellitus (T2DM) incidence continues to rise in the United States, and T2DM prevalence in Hispanics living in the United States is 16.7% in men and 17.2% in women, compared to 8.6% in non-Hispanic White men and 6.6% in non-Hispanic White women. Among adults ≥ 18 years, 4.9 million Hispanic Americans are diagnosed with T2DM (Centers for Disease Control & Prevention [CDC], 2020). T2DM prevalence among Hispanic older adults (> 65 years) is not specified by the CDC, but this group is disproportionately affected by the micro-and macrovascular complications of T2DM (Beard et al., 2009).T2DM ranked seventh as a leading cause of death in the United States in 2017 (CDC, 2020). For individuals living with T2DM, common complications include kidney disease, visual impairment, peripheral circulatory disease, and functional disability (Beard et al., 2009). In adults diagnosed with T2DM, 12% experience vision disability, and 25% have severe stages (3 and 4) of chronic kidney disease (CDC, 2020). The rate of insulin resistance is higher among Mexican Americans compared to non-Hispanic Whites, and the higher rate of obesity among all Hispanics in the United States contributes to a compounded set of risk factors for T2DM complications (Aguayo-Mazzucato et al., 2019). In the contemporary context of the coronavirus pandemic, obese individuals who were diagnosed with T2DM, pharmacologically managed with insulin, and who contracted COVID-19 had a higher mortality rate (Agarwal et al., 2020).Diabetes-related distress (DRD) is a concept that encompasses the burden of lifestyle changes such as diet modification and carbohydrate reduction, the increased difficulty of obtaining healthier, unprocessed foods, daily needle sticks for blood glucose monitoring, the cost of medications and insulin supplies, and the psychological stress from long-term T2DM complications such as kidney failure and limb amputations. In this article, discrimination is conceptualized as "differential and negative treatment of individuals on the basis of their race, ethnicity, gender or other group membership" (Smedley et al., 2003, p. 95). While evidence supporting the relationship between DRD and adverse diabetes-related health outcomes mounts, there is little attention in the literature to the synergistic impact of discrimination and diabetes-related distress on health outcomes in Hispanic adults with T2DM.An anti-immigration sociopolitical climate and hostility towards immigrants, especially those of Hispanic origin, have increased in recent years (Newman et al., 2018) and have been reflected in poor psycho-and physiological outcomes (Andrade et al., 2021). When viewed in comparison to other ethnic minority groups such as non-Hispanic Black Americans, Hispanic Americans experience more negative effects of perceived discrimination (Paradies et al., 2015). In a study of patient-reported experiences of discrimination in the US healthcare system, it was found that 96% of Hispanic participants experienced discrimination, and Hispanic patients were 1.16 t...

Theory Integration for Examining Health Care Discrimination among Minoritized Older Adults with Chronic Illness

“…The first core proposition of the EST states that “people literally embody, biologically, their lived experience, in societal and ecological context” (Krieger, 2012, p. 937). For Latinx older adults with T2DM, this may manifest as increased risk for T2DM and decreased screening (prior to diagnosis), increased depression and depressive symptoms, financial strain, and diabetes-related distress (Olmos & Jones, 2022). Additionally, Latinxs in the United States are known to have higher rates (one in three) of limited English proficiency, higher rates (one in four) of living below the poverty line (compared with Whites), and lower rates (one in three) of not completing high school (Centers for Disease Control and Prevention, 2015).…”

Day-of-the-Week and Time-of-the-Day Patterns of Sedentary Behavior in the Hispanic Community Health Study / Study of Latinos

“…Furthermore, existing studies have had limited representation of underrepresented populations. U.S. Hispanics/Latinos, who consist of the largest U.S. minority population, are disproportionately affected by cardiometabolic risk and health factors (14)(15)(16)(17) and may have distinct temporal patterns of sedentary behavior that require tailored approaches to intervention. The purpose of this cross-sectional study is to characterize the dayof-the-week and time-of-the-day patterns of sedentary behavior among U.S. Hispanic/Latino adults using data from Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the largest cohort study of Hispanic/Latinos in the United States.…”