Access to care, nativity and disease management among Latinos with diabetes in a safety-net healthcare setting

Abstract

Introduction: Latinos in the U.S. are disproportionately affected by diabetes and its complications. The role of access to care and nativity in diabetes management are important areas of research, as these findings can help direct tailored interventions.

Methods: We examined associations between access to care, acculturation and glycemic control among Latino patients with diabetes seen in a safety net emergency department. We used regression models to estimate the individual predictors' associations with glycemic control and then estimated adjusted associations by controlling for all relevant predictors. We tested for a moderating role of nativity in the associations between access to care and glycemic control.

Results: In unadjusted analysis, we found the most significant predictors of glycemic control to be access to primary care (β = -0.89, p = 0.011), capacity for self-monitoring glucose (β = -0.68, p = 0.022), mental health comorbidities (β = 0.95, p = 0.013), male gender (β = -0.49, p = 0.091) and nativity (β = -0.81, p = 0.034). In adjusted analysis, nativity was no longer a significant predictor of glycemic control (β = -0.32, p = 0.541). Nativity did not significantly moderate the association of access to care and glycemic control.

Conclusions: Our findings show a direct association between access to care and glycemic control among low-income Latinos seeking care in the emergency department. This supports concerns that many researchers, clinicians and policy analysts have expressed regarding access to care for immigrants. The importance of primary care and access to supplies to perform self-management in achieving glycemic control and reducing risk of complications indicate that ensuring access to quality care is critical to the health of this vulnerable group.

Keywords: Hispanic Americans; diabetes mellitus; emigrants and immigrants; glycosylated hemoglobin; health services accessibility.