Abstract P232: The Impact of Acculturation on Hyperglycemia and Cardio-Metabolic Risk Factors among Hispanic Adults: Results from the National and Nutrition Examination Survey 1999-2008
Background Higher acculturation has been linked to increased risk of cardiovascular disease risk factors among Hispanics. Whether acculturation is associated with undiagnosed diabetes, pre-diabetes, and diabetes and cardiometabolic risk factors among Hispanics has not been clearly established.
Methods We examined the association between acculturation and undiagnosed diabetes, pre-diabetes, and diabetes among Hispanic adults participating in the National Health and Nutrition Examination Survey (NHANES) from 1999-2008. Acculturation was measured by the validated Short Acculturation Scale (SAS). Undiagnosed diabetes was defined as a hemoglobin A1c (HgA1c) ≥6.5 without a self-report of either diabetes or use of diabetic medications. Pre-diabetes was defined as a HgA1c between 6.0-6.4, and diabetes was defined as HgA1c ≥6.5. Chi-squared analyses were used for comparisons between groups. We used linear and logistic regression models to examine the independent association of acculturation and diabetes, after adjusting for clinical (including having a usual place of care), demographic covariates, and appropriate sampling weights.
Results Of 11, 627 Hispanics with acculturation and laboratory data, 287 had undiagnosed diabetes (mean age 49), 1832 had pre-diabetes (mean age 44), and 1135 had diabetes (mean age 55). Compared to more acculturated Hispanics, less acculturated Hispanics were less likely to be born in the US (23% vs. 83%), have a high school education (40% vs. 66%), have a usual place of care (69% vs. 81%), and to have insurance (55% vs. 78%) (all p<0.001). Undiagnosed diabetes (80% vs. 20%), pre-diabetes (83 % vs. 17%), and diabetes (80% vs.20%) were more prevalent among less acculturated Hispanics (all p<0.001). In fully adjusted models, higher acculturation was associated with lower rates of pre-diabetes (Odds Ratio (OR) 0.62 [95% CI 0.5-0.8]). Less acculturated Hispanics had higher rates of being overweight and obese (67% vs. 61%) compared to more acculturated Hispanics. In fully adjusted models, increasing BMI was associated with higher rates of hyperglycemia [ORs 1.04-1.11 per unit increase in BMI]. Among pre-diabetics and diabetics, less acculturated Hispanics had higher rates of systolic blood pressure ≥130/80. In fully adjusted models, both more acculturated pre-diabetics (OR 2.2 [95%CI 1.0-4.9]) and diabetics (OR 2.9 [95%CI 1.3-6.6]) had suboptimal blood pressure even while on antihypertensive medication.
Conclusion Less acculturated Hispanics have a higher prevalence of undiagnosed diabetes, pre-diabetes, and diabetes. However, more acculturated Hispanics had higher rates of suboptimal blood pressure control. Future interventions need to consider the complex role of acculturation in the growing problem of insulin resistance in the Hispanic population.
- © 2013 by American Heart Association, Inc.