Individual and Community Social Determinants of Health Associated With Diabetes Management in a Mexican American Population

Abstract

Background: Diabetes is a major health burden in Mexican American populations, especially among those in the Lower Rio Grande Valley (LRGV) in the border region of Texas. Understanding the roles that social determinants of health (SDOH) play in diabetes management programs, both at the individual and community level, may inform future intervention strategies.Methods: This study performed a secondary data analysis on 1,568 individuals who participated in Salud y Vida (SyV), a local diabetes and chronic disease management program, between October 2013 and September 2018 recruited from a local clinic. The primary outcome was the reduction of hemoglobin A1C (HbA1C) at the last follow-up visit compared to the baseline. In addition to age, gender, insurance status, education level and marital status, we also investigated 15 community (census tract) SDOH using the American Community Survey. Because of the high correlation in the community SDOH, we developed the community-level indices representing different domains. Using Bayesian multilevel spatial models that account for the geographic dependency, we were able to simultaneously investigate the individual- and community-level SDOH that may impact HbA1C reduction.Results: After accounting for the diabetes self-management education classes taken by the participants and their length of stay in the program, we found that older age at baseline, being married (compared to being widowed or divorced) and English speaking (compared to Spanish) were significantly associated with greater HbA1C reduction. Moreover, we found that the community level SDOH were also highly associated with HbA1C reduction. With every percentile rank decrease in the socioeconomic advantage index, we estimated an additional 0.018% reduction in HbA1C [95% CI (−0.028, −0.007)]. Besides the socioeconomic advantage index, urban core opportunity and immigrant's cohesion and accessibility indices were also statistically associated with HbA1C reduction.Conclusion: To our knowledge, our study is the first to utilize Bayesian multilevel spatial models and simultaneously investigate both individual- and community-level SDOH in the context of diabetes management. Our findings suggest that community SDOH play an important role in diabetes control and management, and the need to consider community and neighborhood context in future interventions programs to maximize their overall effectiveness.

Risk Factors Associated with Diabetes among Mexican-Origin Adults in Southern Arizona

“…This study observed that, at a marginally significant level ( p < 0.1), older adults exhibited better glycemic control, potentially due to a lower degree of insulin resistance and higher participation/engagement in programs [ 2 ]. Furthermore, being female showed a marginal association with diabetes.…”

“…Furthermore, being female showed a marginal association with diabetes. However, previous research among Mexican-origin individuals residing in the US–Mexico border has not provided conclusive evidence regarding the relationship between sex and diabetes [ 2 , 4 , 25 , 26 , 29 ]. Notably, one study found that females had higher levels of physical activity, while males were more likely to adhere to a daily healthy eating plan; both physical activity and a daily healthful eating plan are strongly related to diabetes prevention and management [ 46 ].…”

“…Worldwide, approximately 422 million people have diabetes, and 1.5 million people die each year due to this disease [ 1 ]. Diabetes is the seventh leading cause of death in the United States (US) population, and it is particularly harmful among the Latine population [ 2 , 3 , 4 ]. Between 2017 and 2018, the prevalence of diagnosed diabetes was higher among Latine adults (12.5%) than among non-Latine whites (7.5%) [ 5 ], which contributed to the former’s premature mortality and lower quality of life [ 4 ].…”

“…To the best of our knowledge, the only U.S./Mexico border-wide diabetes prevalence study was carried out at the beginning of the twenty-first century and found a prevalence of 15.7% [ 6 ]. A decade ago, the prevalence of diabetes among two cohorts of Mexican-origin adults living in the US–Mexico border, Lower Rio Valley Grande, Texas, and Douglas, Arizona, was between 21% and 31%, respectively [ 2 , 4 ]. Given the limited literature on US–Mexico border studies on diabetes, this paper examines the prevalence of and risk factors associated with diabetes in three counties of Southern Arizona.…”

Complications in Diabetes Mellitus: Social Determinants and Trends

“…LEA rates in the United States, for example, have dropped significantly among the elderly, with only minor decreases among the young and middle-aged. The number of LEAs continues to be higher among non-Whites and male residents in the United States, with significant geographic differences [ 43 ].…”