Heterogeneity in management of diabetes mellitus among Latino ethnic subgroups in the united states

Background: Recent debate suggests that general racial/ ethnic categories may obscure potentially important subgroup differences within minority groups. The purpose of this study was to examine the quality of diabetes care among ethnic subgroups of the Latino population in the United States while accounting for aspects of acculturation and access to care. Methods: We evaluated adults (>= 18 years old) with previously diagnosed diabetes in the 2003 National Health Interview Survey (n = 2136; United States population estimate = 13,471,587). The Latino subgroups (n = 373; United States population estimate = 1,556,259) were Mexicans, Puerto Ricans, and Other Latinos. Through a series of logistic regressions we examined ethnic group and quality of care for diabetes while controlling for demographics, access to care, and acculturation. Results: Among Latinos, 43% conducted their interview in Spanish and 59% were immigrants to the United States. Ethnic group differences were apparent in the analyses. In a logistic regression analysis including all Latinos, with Puerto Ricans as the reference group, Mexicans (odds ratio, 0.24; 95% CI, 0.07-0.85) and Other Latinos (odds ratio, 0.15; 95% CI, 0.04-0.58) were significantly less likely to have only one doctor for their diabetes care. Mexicans were less likely than Puerto Ricans (odds ratio 0.39; 95% CI, 0.18-0.84) to know about glycosylated hemoglobin. Similarly, among Latino immigrants, Mexicans (odds ratio, 0.13; 95% CI, 0.02-0.81) and Other Latinos (odds ratio, 0.09; 95% CI, 0.01-0.63) were significantly less likely than Puerto Ricans to have only one doctor for their diabetes care and management. Measures of acculturation and immigration were not independent predictors of diabetes quality of care. Conclusions: Differences in diabetes management exist between Latino ethnic subgroups; treating Latinos in the United States as one homogenous category may be a barrier to the appropriate provision of care.