We investigated the effect of race among Hispanic and non-Hispanic people on self-reported diabetes after adjusting for selected individual characteristics and known risk factors.
Methods.
Using the National Health Interview Survey 2000–2003, these analyses were limited to Hispanic and non-Hispanic people who self-identified as white or black/African American for a final sample of 117,825 adults, including 17,327 Hispanic people (with 356 black and 16,971 white respondents).
Results.
The overall prevalence of diabetes was 7.2%. After adjusting for selected covariates, Hispanic white and black respondents were 1.56 (95% confidence interval [CI] 1.32, 1.83) and 2.64 (95% CI 1.10, 6.35) times more likely to report having diabetes than non-Hispanic white respondents. The estimate for non-Hispanic black respondents was 1.45 (95% CI 1.29, 1.64). When compared to low-income non-Hispanic white respondents, low-income Hispanic white respondents (odds ratio [OR] 1.64; 95% CI 1.26, 2.19) and non-Hispanic black respondents (OR 1.71; 95% CI 1.38, 2.11) were more likely to report having diabetes. Hispanic black people born in the U.S. were 3.54 (95% CI 1.27, 9.82) times more likely to report having diabetes when compared to Hispanic white people born in the U.S. In comparison to non-Hispanic white respondents, the odds of reporting diabetes decreased for non-Hispanic black respondents, while the odds remained constant for Hispanic white respondents (p-value for interaction between survey year and race/ethnicity = 0.03).
Conclusions.
This study suggests that race may be a proxy for unmeasured exposures among non-Hispanic and Hispanic people. Thus, given the importance of race on health and the racial heterogeneity among Hispanic people, race among Hispanic people should be investigated whenever the data allow it.
References
1.
Self-reported prevalence of diabetes among Hispanics—United States, 1994-1997. MMWR Morb Mortal Wkly Rep1999; 48(1):8–12.
2.
Prevalence of diabetes among Hispanics—selected areas, 1998-2002. MMWR Morb Mortal Wkly Rep2004; 53(40):941–4.
3.
FreidVMPragerKMackayAPXiaH. Health, United States, 2003, with chartbook on trends in the health of Americans. Hyattsville (MD): National Center for Health Statistics; 2003.
4.
HarrisMIFlegalKMCowieCCEberhardtMSGoldsteinDELittleRR. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care1998; 21:518–24.
5.
CowieCCRustKFByrd-HoltDDEberhardtMSFlegalKMEngelgauMM. Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health and Nutrition Examination Survey, 1999-2002. Diabetes Care2006; 29:1263–8.
6.
FlegalKMEzzatiTMHarrisMIHaynesSGJuarezRZKnowlerWC. Prevalence of diabetes in Mexican Americans, Cubans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982-1984. Diabetes Care1991; 14:628–38.
7.
CowieCCEberhardtMS. Sociodemographic characteristics of persons with diabetes. In: National Diabetes Data Group: diabetes in America. 2nd ed. Bethesda (MD): National Institutes of Health; 1995. p. 85–116.
8.
AmaroHZambranaRE. Criollo, mestizo, mulato, LatiNegro, indigena, white, or black?The US Hispanic/Latino population and multiple responses in the2000 Census. Am J Public Health 2000;90:1724–7.
9.
RodriguezCE. Race, culture, and Latino “otherness” in the 1980 Census. Social Science Quarterly 1992;73:930–7.
10.
RodriguezCE. Challenges and emerging issues: race and ethnic identity among Latinos. Washington: Committee on National Statistics, National Research Council; 1994.
11.
FalcónA. Puerto Ricans and the politics of racial identity. In: HarrisAMBlueHCGriffithEEH, editors. Racial and ethnic identity: psychological development of creative expression. New York: Routledge; 1995. p. 193–207.
12.
WhittenNETorresA. Blackness in Latin America and the Caribbean: social dynamics and cultural transformations. Bloomington (IN): Indiana University Press; 1998.
13.
BacalA. Citizenship and national identity in Latin America: the persisting salience of race and ethnicity. In: OommenAM, editor. Citizenship and national identity: from colonialism to globalism. New Delhi, India: Sage Publications; 1997. p. 281–312.
14.
Martinez-EcházabalL. Mestizaje and the discourse of national/cultural identity in Latin America, 1845-1959. Lat Am Perspect1998; 25:21–42.
15.
BorrellLN. Self-reported hypertension and race among Hispanics in the National Health Interview Survey. Ethn Dis2006; 16:71–7.
16.
SorliePDGarcia-PalmieriMRCostasRJr. Left ventricular hypertrophy among dark- and light-skinned Puerto Rican men: the Puerto Rico Heart Health Program. Am Heart J1988; 116:777–83.
17.
CostasRJrGarcia-PalmieriMRSorliePHertzmarkE. Coronary heart disease risk factors in men with light and dark skin in Puerto Rico. Am J Public Health1981; 71:614–9.
18.
LandaleNSOropesaRS. What does skin color have to do with infant health? An analysis of low birth weight among mainland and island Puerto Ricans. Soc Sci Med2005; 61:379–91.
19.
KriegerN. Embodying inequality: a review of concepts, measures, and methods for studying health consequences of discrimination. Int J Health Serv1999; 29:295–352.
20.
WilliamsDR. Race, socioeconomic status, and health. The added effects of racism and discrimination. Ann NY Acad Sci1999; 896: 173–88.
21.
AraújoBYBorrellLN. Understanding the link between discrimination, mental health outcomes, and life chances among Latinos. Hisp J Behav Sci2006; 28:245–66.
22.
CodinaGEMontalvoFF. Chicano phenotype and depression. Hisp J Behav Sci1994; 16:296–306.
23.
de SalgadoSnyder VN. Factors associated with acculturative stress and depressive symptomatology among married Mexican immigrant women. Psychol Women Quarterly1987; 11:475–88.
24.
StuberJGaleaSAhernJBlaneySFullerC. The association between multiple domains of discrimination and self-assessed health: a multilevel analysis of Latinos and blacks in four low-income New York City neighborhoods. Health Serv Res2003; 38(6 Pt 2):1735–59.
25.
TafoyaS. Shades of belonging. Washington: Pew Hispanic Center; 2004.
26.
TafoyaSM. Latinos and racial identification in California. In: JohnsonAM, editor. California counts population trends and profiles. San Francisco: Public Policy Institute of California; 2003. p. 1–15.
27.
SaenzR. Latinos and the changing face of America. The American People Census2000 Population Reference Bureau. New York: Russell Sage Foundation; 2004.
28.
National Health Interview Survey 2000 (machine-readable data file documentation). Data File Documentation. In: Hyattsville (MD): National Center for Health Statistics, Centers for Disease Control and Prevention; National Center for Health Statistics, 2002 a.
29.
National Health Interview Survey 2001 (machine-readable data file documentation). Data File Documentation. In: Hyattsville (MD): National Center for Health Statistics; 2002 b.
30.
National Health Interview Survey 2002 (machine-readable data file documentation). Data File Documentation. In: Hyattsville (MD): National Center for Health Statistics; 2003.
31.
National Health Interview Survey 2003 (machine-readable data file documentation). Data File Documentation. In: Hyattsville (MD): National Center for Health Statistics; 2004.
32.
GriecoEMCassidyRC. Overview of race and Hispanic origin. Washington: US Census Bureau; 2000.
33.
American Diabetes Association. Screening for type 2 diabetes. Diabetes Care2004; 27(Suppl 1):S11–4.
34.
TullESRosemanJM. Diabetes in African Americans. In: National Diabetes Data Group. Diabetes in America. Bethesda (MD): National Institutes of Health; 1995. p. 613–30.
35.
SchenkerNRaghunathanTEChiuPLMakucDMZhangGCohenAJ. Multiple imputation of family income and personal earnings in the National Health Interview Survey: methods and examples. 2006 [cited 2007 Jan 16]. Available from: URL: http://www.cdc.gov/nchs/data/nhis/tecdoc.pdf
36.
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obesity Res1998; 6(Suppl 2):51S–209S.
37.
WHO Consultation on Obesity. Obesity: preventing and managing the global epidemic. Geneva; 1997 Jun 3–5. Geneva: World Health Organization. WHO Technical Report Series 894; 2000.
38.
SAS/STAT User's Guide: Version 8.0. Cary (NC): SAS Institute Inc.; 1999.
39.
Research Triangle Institute. SUDAAN Language Manual: Release 9.0. Research Triangle Park (NC): Research Triangle Institute; 2004.
40.
KriegerNWilliamsDRMossNE. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health1997; 18:341–78.
41.
RodriguezCE. Changing race. Latinos, the census, and the history of ethnicity in the United States. New York: New York University Press; 2000.
42.
HurtadoAGurinPPengT. Social identities—a framework for studying the adaptations of immigrants and ethnics: the adaptation of Mexicans in the United States. Soc Probl1994; 41:129–51.
43.
De GenovaN. Race, space, and the reinvention of Latin America in Mexican Chicago. Lat Am Perspect1998; 25:87–116.
44.
MartinEDeMaioTJCampanelliPC. Context effects for census measures of race and Hispanic origin. Public Opinion Quarterly1990; 54:551–66.
45.
HazudaHPHaffnerSMSternMPEiflerCW. Effects of acculturation and socioeconomic status on obesity and diabetes in Mexican Americans. The San Antonio Heart Study. Am J Epidemiol1988; 128:1289–301.
46.
MainousAGIIIMajeedAKoopmanRJBakerREverettCJTilleyBC. Acculturation and diabetes among Hispanics: evidence from the 1999–2002 National Health and Nutrition Examination Survey. Public Health Rep2006; 121:60–6.
47.
BrancatiFLKaoWHFolsomARWatsonRLSzkloM. Incident type 2 diabetes mellitus in African American and white adults: the Atherosclerosis Risk in Communities Study. JAMA2000; 283:2253–9.
48.
NgoDLMarshallLMHowardRNWoodwardJASouthwickKHedbergK. Agreement between self-reported information and medical claims data on diagnosed diabetes in Oregon's Medicaid population. J Public Health Manag Pract2003; 9:542–4.
49.
RamirezRDe la CruzGP. The Hispanic population in the United States: March 2002, current population reports, P20-545. Washington: US Census Bureau; 2003.
50.
National Center for Health Statistics. Health, United States, 2005, with chartbook on trends in the health of Americans. Hyattsville (MD): NCHS; 2005.
51.
HarrisMI. Noninsulin-dependent diabetes mellitus in black and white Americans. Diabetes Metab Rev1990; 6:71–90.
