Racial/Ethnic Discrimination and Diabetes-Related Outcomes Among Latinos with Type 2 Diabetes
- 190 Downloads
Discrimination is associated with adverse health outcomes, but few studies have examined the association of discrimination with diabetes-related outcomes including mental health and glycemic control, particularly for immigrant and US-born Latinos. We analyzed survey data (n = 222) collected at baseline of a diabetes intervention. Using multiple linear regression, we examined the association of racial/ethnic discrimination with depressive symptoms, diabetes-related distress, and HbA1c, and variation in these associations by nativity and, for immigrants, length of US residence. Racial/ethnic discrimination was positively associated with depressive symptoms (b = 2.57, SE = 0.45, p < 0.01) and diabetes-related distress (b = 0.30, SE = 0.09, p < 0.01). We could not reject the null hypothesis of no cross-sectional association of racial/ethnic discrimination with HbA1c (b = − 0.27, SE = 0.18, p = 0.14). Although racial/ethnic discrimination did not directly affect HbA1c, racial/ethnic discrimination had a significant mediating effect on HbA1c through diabetes-related distress (p = 0.02). Results suggest that racial/ethnic discrimination is detrimental for health for Latinos with diabetes.
KeywordsLatinos Hispanics Discrimination Unfair treatment Diabetes Depressive symptoms Diabetes-related distress
We thank the Community Health and Social Services (CHASS) and REACH Detroit Partnership staff, the REACH Detroit Partnerships Steering Committee (http://www.reachdetroit.org), and the REACH Detroit Family Intervention Participants for their involvement in this study. The REACH Detroit Partnership is affiliated with the Detroit Community-Academic Urban Research Center (http://www.sph.umich.edu/URC). This research was supported by the National Institute of Diabetes and Digestive and Kidney Disease (R18DK0785501: Spencer, PI), Peers for Progress grant from the American Association of Family Physicians Foundation (Grant P30DK092926) (Michigan Center for Diabetes Translational Research), and by the Centers for Disease Control and Prevention (Cooperative Agreement No. U50/CCU417409). The results presented here are solely the responsibility of the authors and do not necessarily represent the views of the funding sources.
Compliance with Ethical Standards
Conflict of interest
The authors declare no conflict of interest.
The University of Michigan Institutional Review Board approved all study protocols prior to data collection.
- 1.Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017: Estimates of Diabetes and Its Burden in the United States. Atlanta, GA; 2017. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.
- 3.Heisler M. Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study. Arch. Intern. Med. 2007;167:1853. http://www.ncbi.nlm.nih.gov/pubmed/17893306.
- 4.Ali MK, Bullard KM, Imperatore G, Barker L, Gregg EW. Characteristics associated with poor glycemic control among adults with self-reported diagnosed diabetes—National Nutrition Examination Survey, United States, 2007–2010. Mortal Morb Wkly Rep. 2012;61:32–7.Google Scholar
- 7.Lewis TT, Cogburn CD, Williams DR. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu. Rev. Clin. Psychol. 2015. http://www.ncbi.nlm.nih.gov/pubmed/25581238.
- 8.Williams DR, Mohammed SA. Racism and health: pathways and scientific evidence. Am Behav Sci. 2013;57:1199–216.Google Scholar
- 9.LeBron AMW, Valerio MA, Kieffer E, Sinco B, Rosland A-M, Hawkins J, et al. Everyday discrimination, diabetes-related distress, and depressive symptoms among African Americans and Latinos with diabetes. J Immigr Minor Health. 2014;16.Google Scholar
- 11.Hernandez R, Ruggiero L, Riley BB, Wang Y, Chavez N, Quinn LT, et al. Correlates of self-care in low-income African American and Latino patients with diabetes. Health Psychol. 2014;33:597–607. http://www.ncbi.nlm.nih.gov/pubmed/24364373.
- 15.Leyva B, Zagarins SE, Allen NA, Welch G. The relative impact of diabetes distress vs depression on glycemic control in hispanic patients following a diabetes self-management education intervention. Ethn Dis. 2011;21:322–7. http://ezproxy.spu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip&db=cmedm&AN=21942165&site=ehost-live.
- 19.Reynolds DB, Walker RJ, Campbell JA, Egede LE. Differential effect of race, education, gender, and language discrimination on glycemic control in adults with type 2 diabetes. Diabetes Technol Ther. 2015;17:243–7. http://www.scopus.com/inward/record.url?eid=2-s2.0-84925086728&partnerID=tZOtx3y1.
- 21.Wagner JA, Tennen H, Feinn R, Finan PH. Racial discrimination and metabolic control in women with type 2 diabetes. Ethn Dis. 2013;23:421–7. http://www.ncbi.nlm.nih.gov/pubmed/24392603.
- 28.Feathers JT, Kieffer EC, Palmisano G, Anderson M, Janz N, Spencer MS, et al. The development, implementation, and process evaluation of the REACH Detroit Partnership’s Diabetes Lifestyle Intervention. Diabetes Educ. 2007;33:509–20. http://www.ncbi.nlm.nih.gov/pubmed/17570882.
- 29.Two Feathers J, Kieffer EC, Palmisano G, Anderson M, Sinco B, Janz N, et al. Racial and Ethnic Approaches to Community Health (REACH) Detroit partnership: improving diabetes-related outcomes among African American and Latino adults. Am J Public Health. 2005;95:1552–60.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Spencer MS, Rosland A-M, Kieffer EC, Sinco BR, Valerio M, Palmisano G, et al. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health. 2011;101:2253–60. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3222418&tool=pmcentrez&rendertype=abstract.
- 33.Association AD. A1C and eAG. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/. Accessed 17 Aug 2017.
- 34.American Diabetes Association. Diagnosing diabetes and learning about prediabetes. 2017. http://www.diabetes.org/diabetes-basics/diagnosis/?loc=db-slabnav. Accessed 20 Aug 2017.
- 39.Fisher L, Glasgow RE, Strycker LA. The relationship between diabetes distress and clinical depression with glycemic control among patients with type 2 diabetes. J Manag Care Pharm. 2010;33:1034–6. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2858170&tool=pmcentrez&rendertype=abstract.
- 40.Miller T. Border patrol nation: dispatches from the front lines of homeland security. San Francisco: City Lights Books; 2014.Google Scholar
- 41.Cox AB, Miles TJ. Policing immigration. Univ Chicago Law Rev. 2013;80:87–136. http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=86925342&site=ehost-live.
- 43.LeBrón AMW, Schulz AJ, Mentz GB, Reyes A, Gamboa C, Israel BA, et al. Impact of change over time in self-reported discrimination on blood pressure: implications for inequities in cardiovascular risk for a multi-racial urban community. Ethn Health. 2018. https://doi.org/10.1080/13557858.2018.1425378.PubMedGoogle Scholar
- 48.Toomey RB, Umaña-Taylor AJ, Williams DR, Harvey-Mendoza E, Jahromi LB, Updegraff KA. Impact of Arizona’s SB 1070 immigration law on utilization of health care and public assistance among mexican-origin adolescent mothers and their mother figures. Am J Public Health. 2014;104:S28–34.CrossRefPubMedPubMedCentralGoogle Scholar
- 52.Picard M, Juster R-P, McEwen BS. Mitochondrial allostatic load puts the “gluc” back in glucocorticoids. Nat. Rev. Endocrinol. 2014;10:303–10. http://www.nature.com/nrendo/journal/v10/n5/full/nrendo.2014.22.html.
- 57.Crenshaw K. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist policies. Univ Chic Leg Forum. 1989;1989:139–67.Google Scholar
- 58.Collins PH. Black feminist thought: knowledge, consciousness, and the politics of empowerment. Boston: Unwin Hyman; 1990.Google Scholar