224574 Role of Generational Status in Quality of Diabetes Management among Mexicans in California

Tuesday, November 9, 2010

Selena Ortiz, MPH , School of Public Health, University of California, Los Angeles, Los Angeles, CA
Ninez Ponce, MPP, PhD , Department of Health Services, UCLA, Los Angeles, CA
Debra Perez, PhD MPA MA , Robert Wood Johnson Foundation, Princeton, NJ
Diabetes disproportionately affects the Mexican population in the US, with Mexican Americans twice as likely to have diabetes as non-Latino whites. Mexicans span the demographic continuum of recent immigrants to native-born Americans whose families have been in the US for several generations. For this largest Latino group in the US, we hypothesized that generational status is consequential in predicting their quality of diabetes care, and potentially, in reducing diabetes disparities in the US.

Using weighted multivariate logistic regression, we determined the effect of generational status on five diabetes care process measures adjusting for age, gender, poverty level, educational attainment, English proficiency and insurance status per generational level. Four levels of generational status were constructed: first generation immigrant; second generation (US-born with two foreign-born parents); generation 2.5 (US-born with one foreign born parent and one US-born parent); and third generation (US-born with two US born parents). Care process measures include receipt of an annual doctor's visit, an HbA1c test, an eye exam with dilated pupils, a foot exam, and an influenza vaccination within the past year. We also assessed receipt of a hypertension diagnosis, overweight/obesity, communication difficulties with their physician, and the amount of weekly exercise.

Principal Findings Although the odds of being diagnosed with diabetes is higher when compared to first generation Mexicans, third generation Mexicans had reduced odds of receiving an annual eye exam. Generation 2.5 had reduced odds of receiving an annual foot exam than first generation Mexicans. However, both second and third generation Mexicans had increased odds of receiving an annual HbA1c exam. Both second and third generation Mexicans had increased odds of being diagnosed with hypertension. Generation 2.5 Mexicans had decreased odds of experiencing communication difficulties with their primary care provider than first generation Mexicans.

Learning Areas:
Chronic disease management and prevention
Diversity and culture
Public health or related research

Learning Objectives:
Discuss the impact that generational status has on disease management strategies List the diabetes management processes and outcomes that are most affected by generational status Describe the general state of diabetes disease management among Mexican communities Compare quality of diabetes management strategies across varying levels of generational status

Keywords: Quality Improvement, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have extensive health professional experience in the Latino community, particularly in the development of chronic disease management strategies. As a current PhD student, my areas of research focus on Latino health outcomes, in particular access to health care and chronic disease management.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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