Latino Health Disparities; Prevalence and Risk Factors of Diabetes and Depression

Introduction:

The Affordable Care Act of 2010 emphasizes the importance of delivering integrated health and behavioral health treatment in an effort to reduce health disparities and improve a fragmented healthcare system. Integrated treatment is important to address the biological, psychological, and social needs of individuals with co-occurring health and mental health problems. Evidence suggests that integrated treatment enhances access to services, improves quality of care, and overall lowers health care expenditures. One of the health disparities that disproportionately affects the Hispanic population is diabetes. Coexisting depression is an important risk factor associated with suboptimal outcomes in patients with diabetes in the general population. However, little is known about the rate of coexisting depression in Latinos with diabetes and associated risk factors. This study builds on current literature and aims to describe the current prevalence and risk factor of Latinos suffering from diabetes with and without depression.

 

Methods:

The analytic sample includes adult respondents aged 18 years and older surveyed from the 2006-2015 National Health Interview Survey (NHIS; N=296,802). Conducted annually, the NHIS is a national representation of the civilian, non-institutionalized population in the United States. The NHIS uses a multistage area probability sampling design. Weighted binary logistic regression was used to examine risk factors (e.g., sociodemographics, racial identity and cultural factors, diabetes characteristics, overall health status, and insurance access) of coexisting diabetes and depression (CDD) in a national sample of Latino adults.

 

Results:

Of the 50,985 Latino adults in the sample, approximately 9.3% reported having diabetes. Among those with diabetes, about 10% had CDD. Rates of CDD varied among Latino subgroups, with the highest rates found among Mexican (32%) and Mexican-American (22%) groups, followed by Puerto Rican (18%), Central American (10%), Cuban/ Cuban American (6%), and Dominican (5%) groups. A greater percentage of Latinos who were women, not born in the US (65%), and who lived in the US for 15+ years (89%) had CDD compared to diabetes-only. Latinos with CDD versus diabetes-only reported an earlier onset of diabetes with an average BMI of 34.6. The multivariate results suggest significantly higher odds of CDD among those who reported being divorced/separated (OR=1.95; 95%CI=1.31-2.89), living with a partner (OR=1.86; 95%CI=1.05-3.29), unemployed (OR=2.46, 95%CI=1.07-5.66), not working due to a disability (OR=2.84, 95%CI=1.83-4.41), not working for other reasons (OR=1.71, 95%CI=1.05-2.77), having fair/poor health (OR=4.15; 95%CI=2.97-5.79), and not US-born (OR=1.38, 95%CI=1.02-1.87). CDD was negatively associated with age (OR=.98, 95%CI=0.96-0.99).

 

Conclusions and Implications:

The current study found considerable diversity in the rates of CDD among Latino subgroups. Prevalence of co-occurring depression and diabetes in Latino adults was positively associated with being divorced/separated, living with a partner, unemployed, living with a disability, and having fair/poor health, but was negatively associated with age. Ongoing research is needed to explore how sociodemographic, psychological, and cultural factors intersect with diabetes and depression in the Latino population. Health disparities in both diabetes and depression continue to be a concern for Latinos. The results suggest the need for integrated health care to improve health and mental health outcomes.