Department of Psychology, Indiana University-Purdue University Indianapolis.
Diabetes Translational Research Center, Indiana University School of Medicine.
Health Psychol. 2018 Jan;37(1):61-69. doi: 10.1037/hea0000552. Epub 2017 Oct 9.
Although treatment disparities in diabetes have been documented along racial/ethnic lines, it is unclear if immigrant groups in the United States experience similar treatment disparities. Our objective was to determine whether immigrant status is associated with differences in pharmacological treatment of diabetes in a nationally representative sample of adults with diabetes. We were specifically interested in differences in treatment with oral hypoglycemic agents (OHA) and insulin.
Respondents were 2,260 adults from National Health and Nutritional Examination Survey (NHANES) 2003-2012 with a self-reported diabetes diagnosis. Immigrant status was indicated by birth within (U.S.-born) or outside (foreign-born) the 50 U.S. States or Washington, DC. Multinomial logistic regression analyses examined associations between immigrant status and (a) treatment with OHAs only and (b) treatment with insulin only or insulin and OHA combination therapy, using no treatment as the reference group.
Adjusting for demographics, diabetes severity and duration, cardiovascular disease (CVD), and CVD risk factors, being foreign-born versus U.S.-born was not associated with treatment with OHAs only (odds ratio [OR] = 1.59; 95% confidence interval [CI] [0.97, 2.60]). However, being foreign-born was associated with decreased odds (OR = 0.53; 95% CI [0.28, 0.99]) of treatment with insulin.
Pharmacological treatment of diabetes differs along immigrant status lines. To understand these findings, studies capturing the processes underlying treatment differences in diabetes among immigrants are needed. Findings raise the possibility that integrating information about a patient's immigrant status, in addition to racial/ethnic identity, may be an important component of culturally sensitive diabetes care. (PsycINFO Database Record
尽管已有研究表明糖尿病的治疗差异存在于不同种族/族裔群体之间，但在美国，移民群体是否也存在类似的治疗差异尚不清楚。本研究旨在确定在具有全国代表性的糖尿病成年患者样本中，移民身份是否与糖尿病的药物治疗差异相关。我们特别关注口服降糖药（OHA）和胰岛素治疗方面的差异。
本研究的受访者为来自国家健康和营养调查（NHANES）2003-2012 年的 2260 名成年人，这些受访者自我报告患有糖尿病。移民身份由出生于美国（美国出生）或美国以外（外国出生）50 个州或华盛顿特区确定。使用无治疗作为参考组，多分类逻辑回归分析考察了移民身份与（a）仅接受 OHA 治疗和（b）仅接受胰岛素或胰岛素和 OHA 联合治疗之间的关联。
在调整了人口统计学因素、糖尿病严重程度和持续时间、心血管疾病（CVD）和 CVD 风险因素后，与美国出生者相比，外国出生者仅接受 OHA 治疗的可能性没有差异（比值比 [OR] = 1.59；95%置信区间 [CI] [0.97, 2.60]）。然而，与美国出生者相比，外国出生者接受胰岛素治疗的可能性较低（OR = 0.53；95% CI [0.28, 0.99]）。
糖尿病的药物治疗存在移民身份差异。为了理解这些发现，需要进行研究以了解移民人群中糖尿病治疗差异背后的过程。这些发现表明，除了种族/族裔身份外，纳入患者移民身份信息可能是实现糖尿病患者文化敏感性护理的重要组成部分。
