Undiagnosed diabetes among immigrant and racial/ethnic minority adults in the United States: National Health and Nutrition Examination Survey 2011–2018

Abstract

Purpose Undiagnosed diabetes disproportionately affects medically underserved groups. It is unknown whether being an immigrant confers additional risk for undiagnosed diabetes. The purpose of this study was to examine independent associations of immigrant status and race/ethnicity with the prevalence of diagnosed and undiagnosed diabetes in a U.S.-based population sample. Methods Respondents were 21,306 adults from the 2011–2018 National Health and Nutrition Examination Survey. Immigrant status was coded as foreign-born or U.S.-born. Six racial/ethnic categories were white, Black, Mexican American, other Hispanic, Asian, and other/multiracial. Self-report and laboratory data yielded a three-level diabetes status outcome: no diabetes (88%), diagnosed diabetes (10%), and undiagnosed diabetes (2%). Results Adjusted multinomial logistic regression models evaluating immigrant status and race/ethnicity as simultaneous predictors revealed that foreign-born (vs. U.S.-born) adults had a similar prevalence of diagnosed diabetes (OR = 0.98, 95% CI: 0.79–1.22, P = .84) but a higher prevalence of undiagnosed diabetes (OR = 1.54, 95% CI: 1.21–1.97, P = .004). Models showed that all racial/ethnic minority groups except the other/multiracial group (vs. whites) had a higher prevalence of diagnosed and undiagnosed diabetes (Ps < .04). Conclusions Immigrants and racial/ethnic minority adults have increased odds of undiagnosed diabetes, even after accounting for health insurance. These groups are likely at increased risk for diabetes complications because of prolonged periods of undetected diabetes.