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Quality of Diabetes Care for Immigrants in the U.S

Dallo, Florence J., Wilson, Fernando A., Stimpson, Jim P.
Diabetes care 2009 v.32 no.8 pp. 1459-1463
cholesterol, compliance, diabetes, education, eyes, health services, immigration, income, influenza, insurance, multivariate analysis, odds ratio, patients, surveys, vaccination, United States
OBJECTIVE: To compare achievement of the American Diabetes Association diabetes care recommendations for U.S.- and foreign-born individuals with diabetes. RESEARCH DESIGN AND METHODS: Using the 2001-2006 Medical Expenditure Panel Surveys, we report estimates for receipt of a cholesterol test, routine checkup, influenza vaccination, eye examination, dental checkup, foot examination, and two or more A1C tests in 1 year for foreign- (n = 1,272) and U.S.-born (n = 5,811) individuals aged greater-than-or-equal18 years. We define a dichotomous variable representing full compliance with the above examinations. We provide descriptive characteristics of the sample and use multivariable analysis for each procedure with random effects logit regression. RESULTS: Compared with U.S.-born individuals with diabetes, foreign-born individuals are younger, have lower education levels and income, are more likely to have public or no insurance, and are less likely to have a usual source of care. With adjustment for all potential confounders, foreign-born individuals are less likely to report having had an influenza vaccination (odds ratio 0.51 [95% CI 0.31-0.71]) or to be compliant with any one of the seven recommendations (0.64 [0.34-0.95]). CONCLUSIONS: These findings demonstrate that immigrants are less likely than U.S.-born individuals with diabetes to adhere to any one of seven diabetes care recommendations in general and, specifically, are less likely to report having received an influenza vaccination. Because immigrants are less likely to use health care, clinicians should take advantage of the office visit to effectively communicate to the patient the importance of receiving an influenza vaccination.