Introduction: About 9.4% of the United States (U.S.) population has diabetes. Diabetes is a prevalent and expensive disease costing more than $320 billion annually. Immigrants, about 13% of the U.S. population, often lack health insurance and pay out of pocket for healthcare. Immigrants also have cultural and other barriers to accessing healthcare that affect their ability to care for chronic diseases like diabetes. The aim of this study was to examine the relationship between life-course socioeconomic status (SES), acculturation, and out of pocket (OOP) costs among immigrants with diabetes.

Methods: Data from the New Immigrant Survey, a multi-cohort study of U.S. immigrants, was analyzed. Linear regression with OOP costs as the outcome was used to investigate the relationship between acculturation and life-course SES. Additionally, a linear regression model with acculturation as an outcome was run to understand predictors including life-course SES in immigrants with diabetes.

Results: Three hundred seventeen individuals were included in the study. The mean age was 53 years, 56% were female, and 66% had less than high-school level of education. Unadjusted models found an association between acculturation and OOP costs (β: 664.4; p<0.001), which remained significant after adjustment for age, sex, race/ethnicity, marital status, education and income (β: 663.7; p=0.008). Life-course SES was significantly associated with acculturation (β: 0.061; p=0.041) after adjusting for demographics.

Conclusions: Acculturated immigrants with diabetes have higher OOP costs compared to those who are not acculturated. Life-course SES was identified as a significant predictor of acculturation in this sample. Our findings support the idea of acculturation increasing access to care for foreign-born individuals with diabetes. Future research will examine direct and indirect relationships between life-course SES, acculturation, and diabetes outcomes in United States immigrants.


A.Z. Dawson: None. R.J. Walker: None. L.E. Egede: Consultant; Self; Novo Nordisk Inc. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases.


National Institutes of Health

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