Diabetes Screening and Monitoring among Older Mexican-origin populations in the US
Background: The purpose of the study is to examine diabetes screening and monitoring among Latino individuals as compared to non-Latino white individuals, and to better understand how we can use neighborhood data to address diabetes care inequities.
Research Design and Methods: This is a retrospective observational study linked with neighborhood-level Latino subgroup data obtained from the American Community Survey. We used generalized estimating equations negative binomial and logistic regression models adjusted for patient-level covariates to compare annual rates of glycated hemoglobin (HbA1c) monitoring for those with diabetes and odds of HbA1c screening for those without diabetes by ethnicity, and among Latinos living in neighborhoods with low (0.0-22.0%), medium (22.0-55.7%), and high (55.7-98.0%) population percent Mexican-origin.
Results: Latino individuals with diabetes had 18% higher rates of HbA1c testing than non-Latino white individuals with diabetes (aRR=1.18, 95%CI=1.07-1.29), and Latinos without diabetes had 25% higher odds of screening (aOR=1.25, 95%CI=1.15-1.36) than non-Latino white individuals without diabetes. In the analyses where neighborhood-level percent Mexican population was the main independent variable, all Latinos without diabetes had higher odds of HbA1c screening compared to non-Latino white individuals, yet only those living in low percent Mexican-origin neighborhoods had increased monitoring rates (aRR=1.31, 95%CI=1.15-1.49).
Conclusions: These findings reveal novel variation in healthcare utilization according to Latino subgroup neighborhood characteristics and could inform the delivery of diabetes care for a growing and increasingly diverse Latino patient population. Clinicians and researchers whose work focuses on diabetes care should take steps to improve equity in diabetes and prevent inequity in treatment.