Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Child Study Center, Yale University School of Medicine, 350 George Street, New Haven, CT, 06511, USA.
Eat Weight Disord. 2021 Dec;26(8):2673-2682. doi: 10.1007/s40519-021-01138-z. Epub 2021 Feb 16.
To compare prevalence of self-reported diabetes between U.S. state-born, Puerto Rico-born, Mexico-born, Cuba-born, and South/Central America-born Hispanic groups, and examine whether risk for diabetes differs by country of origin and experiences with discrimination when accounting for BMI.
Data from 6223 Hispanic respondents from the nationally representative NESARC-III study was used. Sociodemographic characteristics were compared across nativity groups, and adjusted odds of self-reported diabetes diagnosis (past year) tested. Differences by perceived discrimination (using endorsement of individual items assessing specific experiences) and by nativity were examined when accounting for sociodemographic characteristics, acculturation, and BMI.
Prevalence of self-reported diabetes diagnosis was significantly higher among the Puerto Rico-born Hispanics, and remained significantly elevated when adjusting for perceived discrimination, acculturation, and health risk behaviors. When adjusting further for BMI, there were no significant differences in the odds of diabetes by nativity. Prevalence of lifetime perceived discrimination was significantly lower among Cuba-born Hispanics. Mean BMI was significantly lower in South/Central America-born Hispanic individuals relative to U.S. state-, Mexico-, and Puerto Rico-born Hispanic groups. Higher BMI was associated with significantly greater risk of diabetes diagnosis across groups.
Marked heterogeneity exists in prevalence and in factors associated with diabetes risk and weight status across Hispanic groups in the U.S. Experiences with discrimination may play an important role in accounting for these differences. This should be considered when planning future research to inform the most optimal patient-centered prevention efforts.
Level III, Evidence obtained from well-designed cohort analytic study.
比较美国本土出生、波多黎各出生、墨西哥出生、古巴出生和中/南美出生的西班牙裔人群中自我报告的糖尿病患病率，并研究在考虑 BMI 的情况下，糖尿病的风险是否因原籍国和经历的歧视而有所不同。
使用来自全国代表性 NESARC-III 研究的 6223 名西班牙裔受访者的数据。比较了不同出生群体的社会人口统计学特征，并测试了自我报告的糖尿病诊断（过去一年）的调整后比值比。当考虑到社会人口统计学特征、文化适应和 BMI 时，研究了感知歧视（使用评估特定经历的个别项目的认可）和原籍国的差异。
与美国本土出生的西班牙裔相比，波多黎各出生的西班牙裔自我报告的糖尿病诊断患病率显著更高，并且在调整感知歧视、文化适应和健康风险行为后仍然显著升高。当进一步调整 BMI 时，出生原籍国对糖尿病的患病几率没有显著差异。古巴出生的西班牙裔感知到的终身歧视率明显较低。与美国本土、墨西哥和波多黎各出生的西班牙裔群体相比，中/南美出生的西班牙裔个体的平均 BMI 显著较低。较高的 BMI 与所有群体的糖尿病诊断风险显著增加相关。
在美国的西班牙裔人群中，糖尿病患病率以及与糖尿病风险和体重状况相关的因素存在显著的异质性。歧视经历可能在解释这些差异方面发挥重要作用。在规划未来的研究以告知最佳的以患者为中心的预防措施时，应考虑到这一点。
三级，从精心设计的队列分析研究中获得的证据。
