Association of Acculturation Levels and Prevalence of Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)
- Namratha R. Kandula, MD, MPH1,
- Ana V. Diez-Roux, MD, PHD2,
- Cheeling Chan, MS3,
- Martha L. Daviglus, MD, PHD3,
- Sharon A. Jackson, PHD4,
- Hanyu Ni, PHD, MPH5 and
- Pamela J. Schreiner, MS, PHD6
- 1Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- 2Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
- 3Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- 4Northrop Grumman, Centers for Disease Control and Prevention, Atlanta, Georgia
- 5Division of Epidemiology and Clinical Application, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- 6Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
- Corresponding author: Namratha R. Kandula, n-kandula{at}northwestern.edu
Abstract
OBJECTIVE—The prevalence of type 2 diabetes among Hispanic and Asian Americans is increasing. These groups are largely comprised of immigrants who may be undergoing behavioral and lifestyle changes associated with development of diabetes. We studied the association between acculturation and diabetes in a population sample of 708 Mexican-origin Hispanics, 547 non–Mexican-origin Hispanics, and 737 Chinese participants in the Multi-Ethnic Study of Atherosclerosis (MESA).
RESEARCH DESIGN AND METHODS—Diabetes was defined as fasting glucose ≥126 mg/dl and/or use of antidiabetic medications. An acculturation score was calculated for all participants using nativity, years living in the U.S., and language spoken at home. The score ranged from 0 to 5 (0 = least acculturated and 5 = most acculturated). Relative risk regression was used to estimate the association between acculturation and diabetes.
RESULTS—For non–Mexican-origin Hispanics, the prevalence of diabetes was positively associated with acculturation score, after adjustment for sociodemographics. The prevalence of diabetes was significantly higher among the most acculturated versus the least acculturated non–Mexican-origin Hispanics (prevalence ratio 2.49 [95% CI 1.14−5.44]); the higher the acculturation score is, the higher the prevalence of diabetes (P for trend 0.059). This relationship between acculturation and diabetes was partly attenuated after adjustment for BMI or diet. Diabetes prevalence was not related to acculturation among Chinese or Mexican-origin Hispanics.
CONCLUSIONS—Among non–Mexican-origin Hispanics in MESA, greater acculturation is associated with higher diabetes prevalence. The relation is at least partly mediated by BMI and diet. Acculturation is a factor that should be considered when predictors of diabetes in racial/ethnic groups are examined.
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 5 May 2008.
A complete list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.
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- Received November 15, 2007.
- Accepted April 27, 2008.
- DIABETES CARE
