Background: Racial and ethnically diverse older adults with cognitive limitations and diabetes experience significant challenges with adhere to treatment recommendations, which places an increased burden on health care providers to place culturally appropriate care. Our purpose was to examine associations between a combined measure of race, ethnicity, and nativity status with cognitive limitations and diabetes among foreign-born Arab Americans compared to foreign-born non-Hispanic whites, blacks, Hispanics, Asians and US-born non-Hispanic whites.

Methods: We analyzed restricted, linked data from the 2002-2016 National Health Interview Survey and 2003-2017 Medical Expenditure Panel Survey (ages >=45 years, n=159,341). Logistic regression was used to evaluate the odds of having cognitive limitations with and without diabetes among foreign-born Arab Americans compared to other groups after adjusting for age and sex.

Results: In logistic regression models adjusted for age and sex, higher odds of cognitive limitations were also among foreign-born Arab Americans (OR=1.29; 95% CI=0.76, 2.18) and Hispanics (OR=1.10; 95% CI=0.99-1.22) compared to US-born non-Hispanic whites. Foreign-born non-Hispanic whites had higher odds (OR=1.36; 95% CI=1.05-1.49) of cognitive limitations compared to their US-born counterparts. Foreign-born Hispanics with diabetes had greater odds of cognitive limitations (OR=1.91; 95% CI=1.63, 2.24) compared to US-born non-Hispanic whites. Results were not statistically significant when comparing foreign-born non-Hispanic whites, blacks, Asians and Arab Americans.

Conclusions: This is one of the first studies to examine cognitive limitations with and without diabetes using nationally representative data from minority populations by nativity status. Findings will be discussed within the immigrant health paradox framework.