Diabetes Monitoring in Foreign-Born and US-Born Latino Adults in US Community Health Centers

Roopradha Datta; Jennifer A. Lucas; Miguel Marino; Danielle M. Crookes; Benjamin Aceves; David Ezekiel-Herrera; Andrew Bazemore; John D. Heintzman

doi:10.3122/jabfm.2024.240107R1

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Figure 1.
Adjusted rate ratios of HbA1c monitoring by ethnicity/nativity group compared with non-Latino White population. Negative binomial model adjusted for age at first visit, sex, insurance type, visits per year, body mass index, income as a percent of the federal poverty level, ever having a kidney disease test, ever having diabetes counseling, HbA1c always under 7, and neighborhood social deprivation index score; a, Patients with a known country of birth; b, Latino Patients without a known country of birth.

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Table 1.

Patient Characteristics (n = 43,593)

	Non-Latino White	Foreign-Born Latino	US-Born Latino	Latino with No Country of Birth Recorded
N	11,911	6,454	1,908	23,320
Ethnicity/Nativity group
Non-Latino White	11,911 (100.0)	0 (0.0)	0 (0.0)	0 (0.0)
US-born Latino	0 (0.0)	0 (0.0)	1,908 (100.0)	0 (0.0)
Dominican-born	0 (0.0)	485 (7.5)	0 (0.0)	0 (0.0)
Guatemalan-born	0 (0.0)	886 (13.7)	0 (0.0)	0 (0.0)
Honduran-born	0 (0.0)	198 (3.1)	0 (0.0)	0 (0.0)
Mexican-born	0 (0.0)	3,396 (52.6)	0 (0.0)	0 (0.0)
Salvadoran-born	0 (0.0)	1,225 (19.0)	0 (0.0)	0 (0.0)
Other foreign-born Latino	0 (0.0)	264 (4.1)	0 (0.0)	0 (0.0)
Neighborhood Dominican	0 (0.0)	0 (0.0)	0 (0.0)	1,860 (8.0)
Neighborhood Guatemalan	0 (0.0)	0 (0.0)	0 (0.0)	350 (1.5)
Neighborhood Honduran	0 (0.0)	0 (0.0)	0 (0.0)	90 (0.40
Neighborhood Mexican	0 (0.0)	0 (0.0)	0 (0.0)	20,562 (88.2)
Neighborhood Salvadoran	0 (0.0)	0 (0.0)	0 (0.0)	458 (2.0)
Spanish speaking (Yes)	0 (0.0)	6,107 (94.6)	791 (41.5)	17,918 (76.8)
Age category
18 to 29	368 (3.1)	123 (1.9)	173 (9.1)	780 (3.3)
30 to 39	955 (8.0)	667 (10.3)	244 (12.8)	2,449 (10.5)
40 to 49	2,197 (18.4)	1,577 (24.4)	410 (21.5)	5,405 (23.2)
50 to 59	4,190 (35.2)	2,230 (34.6)	609 (31.9)	7,472 (32.0)
60 to 69	3,210 (26.9)	1,475 (22.9)	374 (19.6)	5,363 (23.0)
70 to 79	991 (8.3)	382 (5.9)	98 (5.1)	1,851 (7.9)
Male sex (Yes)	6,313 (53.0)	2,659 (41.2)	841 (44.1)	10,480 (44.9)
Visits per year (categorical)
<1	1,904 (16.0)	765 (11.9)	279 (14.6)	4,119 (17.7)
1 to 3	3,736 (31.4)	1,669 (25.9)	730 (38.3)	7,346 (31.5)
3.01 to 5	2,633 (22.1)	1,551 (24.0)	390 (20.4)	4,868 (20.9)
>5	3,638 (30.5)	2,469 (38.3)	509 (26.7)	6,987 (30.0)
Insurance
Never insured	789 (6.6)	510 (7.9)	40 (2.1)	4,216 (18.1)
Some private	1,168 (9.8)	296 (4.6)	127 (6.7)	1,697 (7.3)
Some public	8,418 (70.7)	4,568 (70.8)	1,427 (74.8)	14,945 (64.1)
Some private and public	1,536 (12.9)	1,080 (16.7)	314 (16.5)	2,462 (10.6)
Income as % of federal poverty level
Always equal to or over 138	1,488 (12.5)	196 (3.0)	39 (2.0)	1,282 (5.5)
Always under 138	6,109 (51.3)	5,038 (78.1)	726 (38.1)	14,504 (62.2)
Above & below 138	1,860 (15.6)	725 (11.2)	80 (4.2)	2,433 (10.4)
Never documented	2,454 (20.6)	495 (7.7)	1,063 (55.7)	5,101 (21.9)
Overweight body mass index
Never	668 (5.6)	377 (5.8)	94 (4.9)	1,313 (5.6)
Sometimes	1,406 (11.8)	879 (13.6)	213 (11.2)	3,107 (13.3)
Always	9,265 (77.8)	5,033 (78.0)	1,550 (81.2)	18,033 (77.3)
Never recorded	572 (4.8)	165 (2.6)	51 (2.7)	867 (3.7)
Ever had kidney test (Yes)	10,578 (88.8)	5,956 (92.3)	1,752 (91.8)	21,050 (90.3)
Ever had diabetes counseling (Yes)	41 (0.3)	42 (0.7)	24 (1.3)	113 (0.5)
Ever pregnant (Yes)	95 (0.8)	157 (2.4)	53 (2.8)	335 (1.4)
HbA1c always under 7
No	6,527 (54.8)	4,218 (65.4)	1,124 (58.9)	13,701 (58.8)
Yes	2,807 (23.6)	1,187 (18.4)	414 (21.7)	4,705 (20.2)
Never measured	2,577 (21.6)	1,049 (16.3)	370 (19.4)	4,914 (21.1)
Neighborhood social deprivation index score
Low [1, 48)	3,755 (31.5)	369 (5.7)	160 (8.4)	2,177 (9.3)
Medium [48, 79)	3,941 (33.1)	1,085 (16.8)	506 (26.5)	5,379 (23.1)
High [79, 100]	4,215 (35.4)	5,000 (77.5)	1,242 (65.1)	15,764 (67.6)

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Table 2.

Unadjusted Rates of HbA1c Monitoring by Ethnicity/Nativity Group

Ethnicity/Nativity Group	Rate (95% CI)
Non-Latino White	1.00 (0.99–1.01)
US-born Latino	1.00 (0.98–1.02)
Dominican-born	1.37 (1.32–1.43)
Guatemalan-born	1.35 (1.32–1.39)
Honduran-born	1.24 (1.17–1.32)
Mexican-born	1.31 (1.29–1.33)
Salvadoran-born	1.43 (1.40–1.46)
Other foreign-born Latino	1.17 (1.11–1.24)
Neighborhood Dominican	1.41 (1.38–1.44)
Neighborhood Guatemalan	1.07 (1.02–1.12)
Neighborhood Honduran	0.95 (0.85–1.07)
Neighborhood Mexican	1.16 (1.15–1.17)
Neighborhood Salvadoran	1.18 (1.13–1.23)

Abbreviation: CI, Class interval.

Appendix Table 1. Rate Ratios of HbA1c Screening

Ethnicity/Nativity Group
Non-Latino white	Ref
US-born Latino	1.11 (1.02–1.21)
Dominican-born	1.16 (0.98–1.37)
Guatemalan-born	1.05 (0.92–1.20)
Honduran-born	1.07 (0.92–1.24)
Mexican-born	1.06 (0.95–1.19)
Salvadoran-born	1.06 (0.92–1.22)
Other foreign-born Latino	0.97 (0.86–1.10)
Neighborhood proxy Dominican	1.19 (1.07–1.31)
Neighborhood proxy Guatemalan	1.12 (1.03–1.21)
Neighborhood proxy Honduran	1.23 (1.00–1.51)
Neighborhood proxy Mexican	1.22 (1.15–1.29)
Neighborhood proxy Salvadoran	1.08 (0.97–1.19)

Note: Negative binomial model adjusted for age at first visit, sex, insurance type, visits per year, body mass index, income as a percent of the federal poverty level, ever having a kidney disease test, ever having diabetes counseling, HbA1c always under 7, and neighborhood social deprivation index score.