Background: Diabetes is a growing problem among Hispanics living in the United States, who exhibit a higher prevalence and younger age of onset than the general population. Over 25% of those with diabetes in the United States are undiagnosed, and the prevalence of undiagnosed diabetes in the general population increases with age, male gender, and Black/African American or Hispanic race/ethnicity. The purpose of this study is to compare the rates and correlates of undiagnosed diabetes between Hispanic and White American adults with elevated hemoglobin A1C levels.
Methods: Using 2007 to 2012 National Health and Nutrition Survey data, the analysis included 1,792 Hispanic and White American adults age 20 and over, with diagnosed and undiagnosed diabetes. Undiagnosed diabetes was defined as HbA1c level 6.5 or higher, with no previous diagnosis of diabetes. There were 1,398 participants with diagnosis of diabetes by a health care provider, and 352 with elevated HbA1c and no previous diagnosis of diabetes. Those with undiagnosed diabetes were identified with HbA1c value ? 6.5 and no report of a previous diagnosis by a health care provider. Covariates included demographics (age, sex, marital status, education, and ratio of income to poverty), access to health care and health promotion behaviors.
Results: Overall, Hispanics with elevated HbA1c had a higher rate of undiagnosed diabetes than Whites (28.2% vs. 18.0%, p < .001). The highest rate of diagnosed diabetes in Hispanic adults was in those who were 40–49 (19.3%) and older, peaking between with those who were 50–59 (30.3%) and 60–69 (24.6%), and then falling off after age 70 (18.9%). The rate of undiagnosed diabetes started rising in the 30-39 group (17.6%), continued to rise in the 40s (21.6%), and peaked in the 50s (29.4%); 72.5% of those with undiagnosed diabetes were between the ages of 30 and 59.
Hispanics with diabetes were younger (54.92 years vs. 61.45 years, p < .001) and had a higher rate of undiagnosed diabetes (28.2% vs.18.0%, p <.001) than their White counterparts. Covariates that decreased the odds of undiagnosed diabetes among Hispanic adults included having a routine place to receive health care (OR = 0.45, 95% CI [.21, .95], p = .04) and more than one visit to a health care provider in the previous 12 months (OR = 0.17, 95% CI [0.08, 0.38], p < .001). For Whites, covariates that decreased the odds of undiagnosed diabetes were having health insurance (OR = 0.51, 95% CI = [.29, .91], p = .02), and one or more visits to a health care provider in the previous 12 months (OR = 0.09, 95% CI [0.05, 0.16], p < .001), while lower ratio of income to poverty level (OR = 1.19, 95% CI = [1.06, 1.32], p = .002) increased the odds of undiagnosed diabetes in Whites.
Conclusions: The high proportion of undiagnosed diabetes among Hispanic adults suggests the need for increased diabetes awareness education in this population. Understanding the magnitude and direction of association between risk factors and undiagnosed diabetes for Hispanics by nurses can help inform targeted interventions, and development of further research studies to reduce these disparities. In addition, strategies in community nursing to encourage use of health care services would allow earlier identification of elevated HbA1c and prevent or reduce complications.
|Advisor:||Oh, Kyeung Mi|
|Commitee:||Urban, Carol Q., Zhao, Xiaoquan|
|School:||George Mason University|
|School Location:||United States -- Virginia|
|Source:||DAI-B 78/12(E), Dissertation Abstracts International|
|Subjects:||Nursing, Hispanic American studies|
|Keywords:||Diabetes, Health care access, Hispanic americans, Undiagnosed diabetes|
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