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Quality of Diabetes Care Among Recent Immigrants to the USA

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This study investigated the relationship between immigration status and quality of care for patients with diabetes.


We used the Medical Expenditure Panel (MEPS) dataset between 2002 and 2011 to examine the association between quality of care and immigration status. Quality of care was measured by report of dilated eye exam, foot exam, A1C test, an annual doctor’s visit, and having blood pressure checked. Immigration status was defined as US born, non-US born but living in the USA for less than 15 years, and non-US born but living in the USA for more than 15 years. Bivariate analyses were used to compare receiving quality of care and immigration status. Multiple logistic regression was used to examine the association of immigration status with quality of care, adjusting for demographic and medical variables.


Bivariate analyses showed significant differences for all quality of care measures compared to immigration status. However, after adjusting for sociodemographic factors and comorbidities, the only quality of care measures that were significantly associated with immigration status was having blood pressure checked (OR = 0.37 for < 15 years and 0.90 for > 15 years compared to US born, p < 0.001) and having dilated eye exam (OR = 0.77 for < 15 years and 0.89 for > 15 years compared to US born, p = 0.046).


After adjustment for socioeconomic and comorbidity factors, blood pressure testing and dilated eye exams were the only measures significantly associated with immigration status. The highest risk was in the first 15 years after entering the USA and should be a target for interventions.

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This study was supported by Grants T35DK007431 and K24DK093699 from the National Institute of Diabetes and Digestive and Kidney Disease (PI: Leonard Egede).

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Authors and Affiliations



LEE obtained funding for the study. RS, KGB, RJW, JSW, and LEE designed the study; KGB analyzed the data; KGB, RJW, and LEE interpreted the results; RS and KGB drafted the article; and RJW, JSW, and LEE critically revised the manuscript for important intellectual content. All authors approved the final manuscript.

Corresponding author

Correspondence to Leonard E. Egede.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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• Aim is to investigate relationship between immigration status and quality of diabetes care

• Used 12,627 (weighted sample of 12,810,201) that self-reported diabetes from the MEPS dataset

• Differences existed in unadjusted analyses for most quality of care measures

• After adjustment, blood pressure testing and dilated eye exam were the only measures significantly associated with immigration status

• The highest risk groups were those in the first 15 years after entering the USA

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Srivastava, R., Bishu, K.G., Walker, R.J. et al. Quality of Diabetes Care Among Recent Immigrants to the USA. J. Racial and Ethnic Health Disparities 6, 457–462 (2019).

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  • Diabetes
  • Immigration
  • Quality of care
  • Blood pressure