Undiagnosed diabetes among immigrant and racial/ethnic minority adults in the United States: National Health and Nutrition Examination Survey 2011–2018

Abstract

Undiagnosed diabetes disproportionately affects medically underserved groups. It is unknown whether being an immigrant confers additional risk for undiagnosed diabetes. Purpose: To examine independent associations of immigrant status and race/ethnicity with the prevalence of diagnosed and undiagnosed diabetes in a U.S.-based population sample. Methods: Respondents were 21,306 adults from the 2011-2018 National Health and Nutritional Exam Survey.Immigrant status was coded as foreign-born or U.S.-born. Six racial/ethnic categories were: White, Black, Mexican American, other Hispanic, Asian, and Other/Multi-Racial. Self-report and laboratory data yielded a three-level diabetes status outcome: no diabetes (88%), diagnosed diabetes (10%), and undiagnosed diabetes (2%). Results: Adjusted multinomial logistic regression models evaluating immigrant status and race/ethnicity as simultaneous predictors revealed that foreign-born (vs. U.S.-born) adults had a similar prevalence of diagnosed diabetes (OR=0.98, 95% CI: 0.79-1.22, p=0.84) but a higher prevalence of undiagnosed diabetes (OR=1.54, 95% CI: 1.21-1.97, p=0.004). Models showed that all racial/ethnic minority groups except the Other/Multi-Racial group (vs. Whites) had a higher prevalence of diagnosed and undiagnosed diabetes (ps<0.04). Conclusions: Immigrants and racial/ethnic minority adults have increased odds of undiagnosed diabetes, even after accounting for health insurance. These groups are likely at increased risk for diabetes complications due to prolonged periods of undetected diabetes.

Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants

“…Recent research has revealed high prevalence but low awareness of cardiometabolic disease among African immigrants in the U.S. [8,9]. Other studies of African immigrants living in high-income settings have found low levels of health insurance [10] and linkage to primary care [11,12] as well as low or delayed uptake of vaccination [13,14], cancer screening [15,16], antenatal care [17], and diabetes screening [18]. Therefore, identifying and addressing specific barriers to engagement in preventive health care (defined here as proactive measures taken to prevent or mitigate future illness) is needed to improve health outcomes of African immigrant populations in the U.S.…”

Non-Renal Factors Associated with Simultaneous Liver-Kidney Transplant in Patients with End-Stage Liver Disease and Stage 3-5 Chronic Kidney Disease Not Requiring Dialysis

“…Crude and adjusted analyses showed that non-US citizens had 41% and 38% higher odds, respectively than US citizens to receive SLKT (Figure 2 and Figure 3, respectively). The results could be related to the higher prevalence of comorbid advanced CKD in non-US citizens with ESLD due to higher incidence of diabetes [33], lower private insurance coverage rates [34][35][36], and delayed access to dialysis [37].…”

Sick Days: Logical Versus Survey Identification of the Foreign-Born Population in the United States

“…The foreign-born population participates in the labor force at a high rate but also faces systemic obstacles to accessing and utilizing health care. As a result, this population may be less likely to receive a diagnosis for objective health measures such as type 2 diabetes or heart disease (Bacon, Riosmena and Rogers 2017; Barcellos, Goldman and Smith 2012; Hsueh et al 2020). Thus, an encompassing health indicator such as self-reported number of sick days may provide immigration and health researchers an additional and alterative measure of health.…”