Incidence of Type 2 Diabetes
in Hispanics as Compared
to the General Population
in Massachusetts
By Isabelle Pierre
Krystal Amaral,
and Ardrianna Howard,
2014 SEP Participants
1
TYPE 2 DIABETES MELLITUS
Definition:
● A metabolic disease in which the body’s inability to properly use
insulin causes elevated levels of glucose in the blood
● Contrary to type 1 diabetes mellitus where the body is unable to
produce insulin
2
WHAT IS A HEALTH DISPARITY?
The NIH defines a health disparity as:
“The differences in the incidence, prevalence, mortality,
and burden of disease and other adverse health
conditions that exist among specific population groups
compared to a larger group.”
Health disparities limit continued improvement in overall quality of care and
population health and result in unnecessary costs.
3
Hispanic Population in Massachusetts
Asian
5.01%
Hispanic
8.21%
Black
6.21%
American Indian
0.20%
The Massachusetts
population is 8%
Hispanic
White
80.38%
Black
American Indian
White
Asian
Hispanic
CDC National Center for Health, 2013
4
Hispanic vs. General Population
Prevalence of Diabetes: 1990-2007
16
14
Prevalence (%)
12
10
8
Hispanic
White
6
Black
4
2
0
1990
1992
1994
1996
1998
Year
2000
2002
2004
2006
Source data: Massachusetts BRFSS
● 1.6 times more likely to have diabetes than Non-Hispanic Whites
● 1.5 times more likely to die from diabetes compared to Non-Hispanic Whites
5
Leading Causes
Diabetes is the 4th leading cause of death in
Hispanics
●
●
●
●
Genetics
Inequalities in Income and Education
Lifestyle Patterns
Access and Quality of Healthcare
6
Genetics
Strong link to family history and lineage
• Mutations of one gene increase the
risks for developing Type 2 diabetes
• SLC16A11 variation accounts for
about 20 percent of Hispanics'
increased risk of Type 2 diabetes
7
Lifestyle Patterns
2011 BRFSS
Routine Doctor Visits
o Hispanic adults less likely to have visited doctor in the
last year (78.6% versus 85.7%) than Non-Hispanic
White adults
o Less likely to have early detection
Diet and Nutrition
o Higher prevalence of poor diet
Obesity and Overweight
o Hispanic adults are 50% more likely to be obese than
Non-Hispanic Whites.
o 2010 MA Department of Public Health
Family History
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Physical Activity
Physical Activity in the Past Month
85%
Percentage
80%
75%
70%
Hispanic
65%
Black
60%
White
55%
50%
45%
40%
1990
1992
1994
1996
1998
2000
Year
2002
2004
2006
2008
Source data: Massachusetts BRFSS
● 49% of Hispanic students spend three or more hours watching TV
daily compared to 46% of Black students and 27% of Non-Hispanic
White students
2007 MA Youth Risk Behavior Survey
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Inequalities in Income and Education
●
●
●
Individuals in Massachusetts Under 100% Poverty
35%
Percentage Below Poverty (%)
.
43% of Hispanics in Massachusetts do not complete high school compared to 13%
of Non- Hispanic Whites
44% Hispanics reported receiving diabetes education compared to 59% of Whites
Individuals with less income and less education have higher rates of diabetes
29%
30%
25%
22%
20%
20%
15%
15%
10%
10%
7%
5%
0%
White
Black
Asian
Hispanic
AI/AN
Massachusetts
Race
8
Source: US Census Bureau, American Community Survey 3- Year Estimates, 2005-2007
Access and Quality of Healthcare
2011 MA FRBSS
● Uninsured Hispanic adults dropped from 19% to 11% following health
care reform
○Three times as many uninsured Hispanic adult residents compared to
Non- Hispanic Whites.
● 20% of Hispanic adults without a personal health care provider
2010 MA Department of Public Health
Adults Without Personal Health Care Provider
70%
60%
Percent
●
50%
40%
Hispanic
30%
Massachusetts
20%
White
10%
0%
11
2001
2002
2003
2004
2005
Year
2006
2007
2008
Source: MDPH BRFSS 2001-2008
Current News: Project REACH
Racial and Ethnic Approaches to Community Health
Project is based in the Greater Lawrence Family Health Center
Goals:
Work to raise awareness of diabetes and its complications in
the Hispanic population of Massachusetts.
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The Lawrence Latino Diabetes Prevention
Project (LLDPP)
Collaboration with UMass Lowell and UMass Medical School
Goals:
Inexpensive, culturally sensitive intervention program to
improve the incidence of diabetes in the Latino population
of Lawrence.
13
The Lawrence Latino Diabetes Prevention
Project (LLDPP)
Diabetes Care for Latino Residents Treated at the
Greater Lawrence Family Health Center
Percentage (%)
80
70
60
50
40
30
20
10
0
2001
2007
Source: REACH Latino Health Project
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Narrowing The Gap
Culturally tailored interventions
●
●
●
●
Preventative Care
● Recognizing the symptoms
Self- Management
● Less-costly alternative
Nutrition Education
● Better dietary choices
Active Living
● Increased insulin sensitivity
● Decrease total calories to
lose weight
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Conclusion
• Incidence of Type 2 Diabetes is higher in Hispanics than in
the general population
• Socioeconomic factors contribute to disparity
• Awareness campaigns such as Project REACH help raise
awareness and lower the prevalence of diabetes within
high risk communities
“together we can put an end to diabetes”
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Questions?
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References
1. Ockene I. S., Tellez T. L., Rosal, M. C. ,Reed, G. W., Mordes J., Merriam, P. A., Olendzki,B. C., Handelman, G., Nicolosi, R., and
Ma, Y. 2012. Outcomes of a Latino Community-Based Intervention for the Prevention of Diabetes: The Lawrence
Latino Diabetes Prevention Project. American Journal of Public Health
2. Rosal M. C., Ockene I. S., Restrepo A. , White M. J., Borg A., Olendzki B., Scavron J., Candib L., Welch G., and Reed G. 2011.
Randomized Trial of a Literacy-Sensitive, Culturally Tailored Diabetes Self-Management Intervention for Low-Income
Latinos. Diabetes Care 34:838-844
3. Welch G., Allen N. A, Zagarins S. E., Stamp K. D, Bursell S-E. and Kedziora R. J. 2011. Comprehensive Diabetes Management
Program for Poorly Controlled Hispanic Type 2 Patients at a Community Health Center. The Diabetes Educator
35(7):680-688
4. Bhargava A., Wartak S. A, Friderici J and Rothberg M.B. 2014. The Impact of Hispanic Ethnicity on Knowledge and
Behavior Among Patients With Diabetes. The Diabetes Educator 40(3):336-343
5. Welch G, Schwartz C, Santiago-Kelly P. 2001. Diabetes- related Emotional Distress of Hispanic and Non- Hispanic Type
Two Diabetes Patients. Ethnicity & Disease. 17:541-547
6. Massachusetts Department of Public Health. Health of Massachusetts. Boston, MA; April 2010.
7. Connor, A., Baumgartner, R., Baumgartner K., et al. 2012. Associations between TCF7L2 polymorphisms and risk of breast
cancer among Hispanic and non-Hispanic White women: the Breast Cancer Health Disparities Study. Breast Cancer Res
Treat 136(2):593-602
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