Investigation of a Paradox of the Latino Paradox: Social Determinants of Health and the Diabetes Disparity Open Access

Cartwright, Katie Lee (2015)

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Latinos living in the US report a disproportionately high prevalence of diabetes. Simultaneously, Latinos experience unexpected health advantages, including longer life expectancy and lower rates of certain cancers and heart disease. This pattern is called the "Hispanic Paradox." The Latino diabetes disparity has not been considered in the frame of this paradox. When considering both epidemiological patterns, a question emerges: how can the same social determinants of health lead to such powerful health advantages for some health outcomes, while at the same time leading to a great health disparity in regard to diabetes? This dissertation explores this question by examining the associations between social determinants of health and self-reported diabetes within the US Latino population and the associations of these social determinants of health in explaining the difference in self-reported diabetes prevalence between the US Latino population and the non-Latino population. This project uses the National Health Interview Survey (NHIS) data from 2006-2011, accessed via the Integrated Health Interview Series (IHIS) data managed by the Minnesota Population Center (MPC). Logistic regression analyses are used to examine the patterns within the Latino population and Oaxaca-Blinder decomposition is used to examine the patterns explaining the difference in self-reported diabetes between the Latino and non-Latino population. The logistic regression analyses show that Latinos are almost 43% more likely to report being diagnosed with diabetes than non-Latinos. Individual characteristics of age, race, and smoking behaviors are identified as suppressors of the association between Latino identity and diabetes. Conversely, measures of social inequality, social ties, acculturation, and origin of Latino heritage are all potential mediators of the association between Latino identity and diabetes. The Oaxaca-Blinder decomposition shows that individual characteristics (particularly age, race, BMI, and smoking habits), measures of social inequality, measures of social ties, measures of acculturation, and measures of Latino ethnic origins inform the explained difference in self-reported diabetes between the Latino and non-Latino population. Social inequality measures contribute a larger part of the explained difference than social ties measures or acculturation measures.

Table of Contents

Chapter 1: Diabetes & the US Latino Population. 1

Chapter 2: Literature Review. 6

Chapter 3: Theoretical Framework. 34

Chapter 4: Data & Methods. 47

Chapter 5: Summary Statistics & Regression Results. 69

Chapter 6: Oaxaca-Blinder Decomposition Results. 104

Chapter 7: Conclusion. 128

Works Cited. 134

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