Conference Coverage
LAS VEGAS – Hispanic adults have high prevalences of diabetes and related disorders overall, the largest ongoing U.S. health study of this population showed, but there are noteworthy differences by sex and ancestry that argue against a one-size-fits-all approach to care for this population.
Participants in the Hispanic Community Health Study /Study of Latinos are 16,415 individuals aged 18-74 years from four cities (San Diego, Chicago, Miami, and New York) who self identified as Hispanic/Latino. Seventy-nine percent were foreign born.
Among key findings of the study’s 2008-2011 baseline examination, about 35% of participants had metabolic syndrome, 36% had prediabetes, and 17% had diabetes, lead investigator Dr. Larissa Avilés-Santa reported at the annual meeting of the American Association of Clinical Endocrinologists.
Subgroup analyses showed that women were more likely than men to have the abdominal obesity component of metabolic syndrome but less likely to have elevated triglycerides. And individuals of Cuban ancestry were the most likely to have high blood pressure.
There were similar variations for prediabetes (most common in participants of Mexican ancestry and least common in those of Dominican ancestry) and diabetes (most common in those of Dominican, Puerto Rican, and Mexican ancestry and least common in those of South American ancestry).
"One of the main messages is that Hispanics are not a monolith. It has been assumed for a long time that Hispanics are a very homogenous group ... and that is not the case. Although we have cultural, historical, religious similarities, we also have differences," she commented in a press briefing. "Assuming homogeneity is not the way to address clinical care with Hispanics. It’s better to ask questions, to get to know the patient – where the patient is coming from – and then go from there."
The observed differences may stem from factors related to both country of origin and current living environment, proposed Dr. Avilés-Santa, who is a medical officer with the division of cardiovascular sciences of the National Heart, Lung, and Blood Institute in Bethesda, Md. Those factors could range from the more easily measured (genetics, diet, and language barriers) to the harder to pin down (health policy, discrimination, health-related beliefs, and religion).
"All of that, taken into consideration, is important because all of it may be playing a big role in the differences that we are observing among Hispanic groups," she maintained.
Additional study data showed the age-adjusted prevalence of hypertension was about 25% among participants overall ( Am. J. Hypertens. 2014;27:793-800 ). It was lowest for those of Mexican and South American ancestry and highest for those of Puerto Rican and Dominican ancestry.
The proportion of participants aged 18-64 years who lacked health insurance ranged from 29% in New York to 71% in Miami. Among older participants, it ranged from 4% in New York to 26% in San Diego. "This is ... a question about policy because the majority who are insured are insured through Medicare. So what is happening with the Hispanic elders? And what is happening with their health if they are not having appropriate insurance coverage?" Dr. Avilés-Santa asked.
The data raise the question as to whether current screening practices for the general population are appropriate for Hispanics, she said. Also, they suggest there are as yet unidentified risk and protective factors at work when it comes to the development of diabetes.
In the study’s longitudinal component, the investigators are following the participants by telephone annually and will reexamine them later this year. Follow-up will continue through at least 2019.
In addition to disseminating the findings to the various communities, the investigators have collected DNA samples and are exploring associations of genetic variants with health measures and outcomes through the Omics in Latinos (OLa) project.
Dr. Avilés-Santa had no relevant conflicts of interest.