Rural residence and Hispanic ethnicity: Doubly disadvantaged for diabetes?
Rural residence and Hispanic ethnicity: Doubly disadvantaged for diabetes?
复制标题
DOI：
10.1111/j.1748-0361.2006.00009.x
复制
发表时间：
2006-12-01
影响因子：
4.9
通讯作者：
Geesey, ME
中科院分区：
文献类型：
--
作者：
Koopman, RJ;Mainous, AG;Geesey, ME
背景：西班牙裔美国人患糖尿病的风险增加，而农村居民获得医疗服务的机会历来较少。目的：确定居住在农村地区和西班牙裔是否会给糖尿病的诊断和控制带来特殊的风险。方法：对1988-1994年第三次全国健康与营养调查结果进行分析。西班牙裔和非西班牙裔白人成年人根据农村/城市居住情况进行分类，形成4个种族居住群体。调查的结果是先前诊断和未诊断的糖尿病。在诊断为糖尿病的患者中，我们调查了血糖、高血压和血脂的控制情况。发现：诊断糖尿病的患病率在农村居民中最高，特别是在农村西班牙裔（8.2%），而城市白人（4.6%），农村白人（6.5%）或城市西班牙裔（4.5%），（P < 0.01）。然而，城市西班牙裔最有可能患有未确诊糖尿病（3.7%），而农村白人为2.3%，城市白人为2.8%，农村西班牙裔为2.7% （P = 0.04）。在诊断为糖尿病的人群中，四组之间的血糖控制没有差异。诊断为糖尿病的拉美裔农村人收缩压升高的患病率最高，为45%，而城市白人为37%，农村白人为29%，城市拉美裔为28% （P = 0.01）。在控制潜在混杂因素的回归模型中，城市和农村白人和西班牙裔在未确诊糖尿病的可能性或确诊糖尿病患者的血糖控制方面没有差异。结论：针对西班牙裔健康，特别是糖尿病的举措，应承认农村/城市西班牙裔健康差异。
Context: Hispanics are at increased risk for diabetes, while rural residents have historically had decreased access to care. Purpose: To determine whether living in a rural area and being Hispanic confers special risks for diagnosis and control of diabetes. Methods: We analyzed the Third National Health and Nutrition Examination Survey (1988-1994). Hispanics and non-Hispanic white adults were classified according to rural/ urban residence to create 4 ethnicity-residence groups. Investigated outcomes were previously diagnosed and undiagnosed diabetes. Among those with diagnosed diabetes, we investigated control of glucose, hypertension, and lipids. Findings: The prevalence of diagnosed diabetes was greatest for rural residents, especially for rural Hispanics (8.2%) versus that for urban whites (4.6%), rural whites (6.5%), or urban Hispanics (4.5%), (P < .01). However, urban Hispanics were most likely to have undiagnosed diabetes at 3.7%, versus 2.3% of rural whites, 2.8% of urban whites, and 2.7% of rural Hispanics (P = .04). Among people with diagnosed diabetes, there was no difference in glycemic control between the 4 groups. Rural Hispanics with diagnosed diabetes had the greatest prevalence of elevated systolic blood pressure at 45%, compared to 37% of urban whites, 29%, of rural whites, 28%, of urban Hispanics (P = .01). In regression models controlling for potential confounders, there were no differences among urban and rural whites and Hispanics in the likelihood of undiagnosed diabetes or in glycemic control for those with diagnosed diabetes. Conclusions: Initiatives that target Hispanic health, and especially diabetes, should acknowledge rural/urban Hispanic health differences.