US Immigrants Provided Less Diabetes Care

Dr. Florence J. Dallo of Oakland University in Rochester, Michigan and her colleagues found that being foreign-born halved a diabetic person's likelihood of getting a flu shot, while diabetic immigrants were also about a third less likely to be in compliance with any one of the American Diabetes Association's (ADA) seven recommendations for diabetes care.

Overall, Dallo and her team note, just half of Americans with diabetes have their blood sugar under control, while about 40 percent have their blood pressure under control. And minority individuals with diabetes are less likely to have their blood sugar or blood pressure under control than whites, they note.

The foreign-born US population is growing, Dallo and her colleagues add, and several studies suggest that immigrants are less likely to have health insurance coverage or a regular source of health care.

To investigate whether immigrants are getting adequate diabetes care, the researchers looked at data from the 2001-2006 Medical Expenditure Panel Surveys, which gathered data from US households on healthcare spending.

Their analysis included 1,272 foreign-born adults and 5,811 US-born citizens, all of whom had diabetes.

The ADA recommends that people with diabetes have routine checkups, cholesterol tests, influenza immunization, eye exams, dental checkups, foot exams, and at least two tests a year measuring hemoglobin A1c -- an indicator of long-term blood sugar control.

Overall, the researchers found, immigrants were younger, less educated, poorer, more likely to be uninsured or to have public rather than private insurance, and less likely to have a usual source of medical care.

After the researchers accounted for these factors, they found that immigrants were less likely than native-born citizens to have had a flu shot, and less likely to be following any one of the ADA's recommendations.

The next step, according to Dallo and her team, will be to investigate why immigrants are less likely to be getting certain types of diabetes care.

While immigrants are actually healthier, overall, than US born citizens, they add, "Foreign born individuals are a vulnerable population, and their health may worsen with increased length of stay in the US."

Diabetes Care, August 2009.