Mechanisms of Diabetes and Diabetic Complications in a Multi-Ethnic Population

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ABSTRACT Racial and ethnic minority populations bear a disproportionate burden of diabetes and lifetime risk for diabetes-related complications in the United States, yet little is known about the risks and disease management challenges associated with diagnosed diabetes and diabetic complications in Native Hawaiian and Pacific Islander (NHPI) populations. This population faces specific vulnerabilities due to their heterogeneous composition when compared to other racial and ethnic populations; represented by indigenous (Native Hawaiian), migrant (e.g., Chamorro, American Samoan, and Marshallese) and immigrant (e.g., Tongan, Fijian, and Vanuatuan) components. The differing histories and experiences of these groups require a culturally competent understanding of the factors that describe their unique diabetes and diabetic complication risks and intervention targets. The central concern motivating this study is the potential underestimation of the risk of developing diabetes among NHPI groups and resulting disparities being masked by the more frequent studies of larger established racial groups. Recent analyses of clinical and population level data do show differences in elevated rates of diabetes in Pacific Islander and Asian subgroups compared to Whites, Hispanics, and African Americans. However, these epidemiological studies fail to capture the social mechanisms critical to understanding how diagnosed diabetes and diabetic complications operate in heterogeneous populations. The paucity of data on NHPI populations has represented a major barrier in addressing health disparities, which is central to achieving health equity. This application will examine a large cross-sectional survey of respondents (N=8,661) collected by the National Center for Health Statistics. The Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS) was specially designed to measure the health and healthcare utilization of the civilian noninstitutionalized NHPI population as of 2014. Using these data, the project will: 1) describe the prevalence and distribution of diagnosed, diabetes and diabetic complications in NHPI populations; 2) determine the sociodemographic profile and social correlates associated with diagnosed diabetes in NHPI adults, and 3) determine the sociodemographic profile and social correlates associated with diagnosed diabetic complications in NHPI adulthood. These analyses will expand our understanding of critical demographic and social factors associated with diagnosed diabetes and diabetic complication in NHPI populations. Study findings will provide important insights to support the development of subsequent research, new clinical studies, and culturally appropriate interventions aimed at reducing diabetes disparities and improving diabetes outcomes within multi-ethnic populations.