Real-World Association of Insurance Status with Cardio-metabolic Risk for Hispanic/Latino Adults Living on the Central Coast of California

  • Ceara AxelrodEmail author
  • Wendy Bevier
  • Banruo Yang
  • Jenny Martinez
  • Jamie Creason
  • David Kerr
Original Paper


The primary aim of this study was to evaluate cardio-metabolic burden by insurance status for Hispanic/Latino adults in Santa Barbara, CA. HbA1c, body mass index (BMI), and health insurance status were evaluated via community-based screenings. Cardiovascular (CV) risk was assessed using the Framingham Heart Study calculator and compared with a National Health and Nutrition Examination Survey background population. Of 593 participants (73% female, age 47.3 years (SD ± 15.2), 44.5% had no insurance or did not know if they had insurance. 16% had an HbA1c in the diabetes range, comprised of 9% self-reporting diabetes and 7% self-reporting no diabetes. 39% had an HbA1c in the prediabetes range. Elevated HbA1c was associated with significantly higher BMI (p = 0.003) and lack of health insurance (p = 0.031). 10-year CV risk was significantly higher than the general population (p < 0.001). This program identified a high burden of cardio-metabolic disease and uninsurance coverage in Hispanic/Latino adults in Santa Barbara.


Health disparities Cardiovascular risk Type 2 diabetes Prediabetes Health insurance Latino Hispanic 



We gratefully acknowledge financial support from Cottage Health, the Towbes Foundation, and the Crawford Idema Foundation. We also thank all of the organizations who hosted MHS events and all staff who conducted the events, especially the Promotores de Salud, who were instrumental in allowing us to reach the local Hispanic/Latino community in a meaningful and culturally competent manner.


  1. 1.
    National Center Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville: Centers for Disease Control and Prevention; 2017.Google Scholar
  2. 2.
    Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics-2016 update: A report from the American Heart Association. Circulation. 2016;133:e38–60.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Aviles-Santa ML, Colon-Ramos U, Lindberg NM, Mattei J, Pasquel FJ, Perez CM. From Sea to Shining Sea and the Great Plains to Patagonia: a review on current knowledge of diabetes mellitus in Hispanics/Latinos in the US and Latin America. Front Endocrinol (Lausanne). 2017;8:298.CrossRefGoogle Scholar
  4. 4.
    Beydoun MA, Beydoun HA, Mode N, et al. Racial disparities in adult all-cause and cause-specific mortality among us adults: mediating and moderating factors. BMC Public Health. 2016;16:1113.CrossRefGoogle Scholar
  5. 5.
    Fisher-Hoch SP, Vatcheva KP, Rahbar MH, McCormick JB. Undiagnosed diabetes and pre-diabetes in health disparities. PLoS ONE. 2015;10:e0133135.CrossRefGoogle Scholar
  6. 6.
    Gellad WF, Haas JS, Safran DG. Race/ethnicity and nonadherence to prescription medications among seniors: results of a national study. J Gen Intern Med. 2007;22:1572–8.CrossRefGoogle Scholar
  7. 7.
    Golden SH, Brown A, Cauley JA, et al. Health disparities in endocrine disorders: biological, clinical, and nonclinical factors–an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2012;97:E1579–E16391639.CrossRefGoogle Scholar
  8. 8.
    Canedo JR, Miller ST, Schlundt D, Fadden MK, Sanderson M. Racial/ethnic disparities in diabetes quality of care: the role of healthcare access and socioeconomic status. J Racial Ethn Health Disparities. 2018;5:7–14.CrossRefGoogle Scholar
  9. 9.
    D'Agostino RB Sr, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117:743–53.CrossRefGoogle Scholar
  10. 10.
    Bitton A, Gaziano TA. The Framingham Heart Study's impact on global risk assessment. Prog Cardiovasc Dis. 2010;53:68–78.CrossRefGoogle Scholar
  11. 11.
    National Center for Health Statistics. National Health and Nutrition Examination Survey 2013–2014. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, HyattsvilleGoogle Scholar
  12. 12.
    American Diabetes Association. Standards of medical care in diabetes-2017 abridged for primary care providers. Clin Diabetes. 2017;35:5–26.CrossRefGoogle Scholar
  13. 13.
    Schneiderman N, Llabre M, Cowie CC, et al. Prevalence of diabetes among Hispanics/Latinos from diverse backgrounds: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Diabetes Care. 2014;37:2233–9.CrossRefGoogle Scholar
  14. 14.
    Davidson MB, Duran P, Lee ML. Community screening for pre-diabetes and diabetes using HbA1c levels in high-risk African Americans and Latinos. Ethn Dis. 2014;24:195–9.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Health CHP. Cottage Health Community Health Needs Assessment Report, 2016. Santa Barbara: Cottage Health; 2016.Google Scholar
  16. 16.
    Babey SH, Wolstein J, Diamant AL, Goldstein H. Prediabetes in California: nearly half of california adults on path to diabetes. Policy Brief UCLA Cent Health Policy Res. 2016;PB2016-1:1–8.Google Scholar
  17. 17.
    Barnett JC, Berchick ER. Health Insurance Coverage in the United States: 2016. Washington DC: US Government Printing Office; 2017. p. 60–260.Google Scholar
  18. 18.
    United States Census Bureau. QuickFacts Santa Barbara County. UNITED STATES: California; 2017.Google Scholar
  19. 19.
    United States Census Bureau. American Fact Finder. American Community Survey 1-Year Estimates. 2015.Google Scholar
  20. 20.
    Screening for Diabetes. Diabetes Care. 2002;25:s21–s2424.CrossRefGoogle Scholar
  21. 21.
    Tang TS, Funnell M, Sinco B, et al. Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial. Diabetes Care. 2014;37:1525–34.CrossRefGoogle Scholar
  22. 22.
    Creason J, Conneely M, Axelrod C, Bevier W, Swartzentruber J, Kerr D. Ocho Pasos a la Buena Salud (Eight Steps to Better Health)—a Diabetes Education Program for Low-Literacy Latinos With or at Risk for Type 2 Diabetes (T2D). Diabetes. 2018;67(Supplement 1):670.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Sansum Diabetes Research InstituteSanta BarbaraUSA

Personalised recommendations