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The Quality of Diabetes Management Among Mexican Adults in California

Does Generational Status Matter?

Ortiz, Selena E., PhD, MPH*; Perez, Debra J., MPA, MA, PhD; Ponce, Ninez A., MPP, PhD

doi: 10.1097/MLR.0000000000000400
Original Articles
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Background: Although there is increasing knowledge regarding the association between generational status on diabetes risk, less is known about the effects of generational status on diabetes management among Mexicans.

Objectives: We test whether generational status is associated with variations in diabetes processes of care among Mexican adults to optimize disease management.

Research Design: Weighted multivariate logistic regression was used to test the association between generational status on the quality of diabetes care processes and health care utilization adjusting for socioeconomic/demographic factors. Four generational cohorts were constructed: first generation immigrant; second generation; generation 2.5; and third generation.

Subjects: We conducted analyses of 3072 self-identified foreign and US-born Mexican adults with diabetes who participated in the 2005, 2007, 2009, and 2011/2012 California Health Interview Surveys.

Measures: Three diabetes process outcomes were measured, including receipt of at least 1 eye examination, 1 foot examination, or 1 hemoglobin A1C test (HbA1c) in the past year. One secondary prevention outcome was measured, receipt of an annual influenza vaccine. Finally, we measured whether an individual with diabetes received an annual doctor visit.

Results: A gradient of progressively decreased odds of receiving an eye examination and HbA1c test were observed and significant for most of the higher generations. Higher generations also had significantly decreased odds of receiving an annual flu vaccine.

Conclusions: Data collection on generational granularity and a specific focus on mixed acculturation status can vitally inform health system improvements in diabetes care among Mexicans in the United States.

*Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA

Annie E. Casey Foundation, Baltimore, MD

Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA

This project was supported by the Network for Multicultural Research on Health and Healthcare at the Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, with funding from the Robert Wood Johnson Foundation. We thank Michael Rodriguez, MD, for his advice and assistance with the study.

The authors declare no conflict of interest.

Reprints: Selena E. Ortiz, PhD, MPH, Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA 02138. E-mail:

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