Diabetes: Health Inequity of Mexican Immigrants in the United States

BY ANABEL STAROSTA

In the United States, Latino immigrants are especially affected by certain illnesses due to social and structural factors beyond their control. Latino immigrants often work as disenfranchised laborers, experience ethnic and cultural discrimination, and remain in low socioeconomic conditions. 1 While certain negative health outcomes are equally prevalent across the greater Latino population, Mexican immigrants in particular are affected by diabetes mellitus. Rates of diabetes in Mexican immigrant populations are among the highest in the country, yet immigrants’ access to preventive care is among the lowest, creating a problematic contrast.

The prevalence of diabetes in the Mexican immigrant population in the United States is concerning and deeply related to sociopolitical and cultural factors. Studies have shown that Mexicans who have lived in the United States for over ten years have the highest prevalence rate of diabetes mellitus of any subgroup, at 10%.² Furthermore, the study found that participants born in the United States and those who had immigrated less than five years ago had similar rates of diabetes.³ This time frame is significant: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) found that diabetes prevalence increased with age from 2.6% for people aged 18 to 29 years to 48.4% in people aged 70 to 74 years. This connection between length of residence and rate of diabetes illustrates that the disparity between Mexican and non-Latino diabetes incidence is preventable and due to sociocultural and structural forces such as poverty and discrimination that act with time.

The role of these detrimental forces is fairly easy to discern. In the general population, diabetes prevention measures such as well-balanced diet, physical activity, improved access to healthy foods, and social support are known and more actively implemented.⁴ However, among Mexican immigrant communities, there is little to no health education. This is linked to the fact that most of these communities are low-income and lack funding not only for education initiatives, but also generally lack access to medical services. Access to healthcare is limited for all immigrants, and although some do receive health insurance through the Affordable Care Act, thousands of undocumented immigrants do not have access to healthcare and risk deportation if they seek it. Diabetes treatment requires close control, and inadequate care can lead to other health consequences. For example, glycemic control is one important aspect of diabetes regulation, and is described by A1C glycosylated hemoglobin levels, which must be closely monitored. A 0.5% decrease in A1C is associated with a 10.5% decrease in risk of vascular complications. 3 However, because many people receive no treatment, they are at high risk for complications.

Financial or legal barriers often prevent people from seeking treatment. Studies in neighborhoods with large Latino populations in Houston, El Paso, Fresno and Los Angeles found that 39% of undocumented adult immigrants feared seeking any sort of medical services because of undocumented status, despite also reporting that they were in need of medical attention. Because Mexican immigrants are the largest undocumented immigrant community in the United States, these statistics are significant to the broader health ecosystem.⁵ Despite the known prevalence of diabetes in this population, very few members of the Mexican community undergo screening: Only 42% of women and 26% of men are typically screened.

Together, these statistics and the demonstrated contribution of sociocultural factors to the high rates of diabetes in the Mexican immigrant population give us much to consider as we tackle questions related to both health and immigration policy. Lack of health insurance and health education is incredibly debilitating to immigrant communities, and the political discourse in our society adds tension to these conversations. These problems compound to increase negative health outcomes in the Mexican population. However, from a humanitarian and public health standpoint, the goal should be to attempt to increase health equity for all – including Mexican immigrants. Thus, this forces us to ask hard questions about how the health of a community with such limited resources and such legal barriers can be improved, and they are questions worth trying to answer.

Anabel Starosta is a pre-med student majoring in History of Science, Medicine and Public Health. She can be contacted at anabel.starosta@yale.edu

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References:

1. Vega, W. A., Rodriguez, M. A., Gruskin, E. (2009). Health Disparities in the Latino Population. Epidemiologic Reviews, 99-112.

2. “ Migration and Health: Mexican Immigrants in the U.S.” Unidad de Política Migratoria. October 2013.

3. Schneiderman, N., Llabre, M., Cowie, C. C., Barnhart, J., Carnethon, M., Gallo, L. C., … Aviles-Santa, M. L. (2014). Prevalence of diabetes among Hispanics/ Latinos from diverse backgrounds: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Diabetes Care, 37, 2238.

4. Page-Reeves, Janet, Mishra, Shiraz I., Niforatos, Joshua, Regino, Lidia, Bulten, Robert. (2013). “An Integrated Approach to Diabetes Prevention: Anthropology, Public Health, and Community Engagement.” The Qualitative Report, 98, 1-22.

5. Berk, M. L., Schur, C. L. (2001). The Effect of Fear on Access to Care Among Undocumented Latino Immigrants. Journal of Immigrant Health, 3, 151.