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Immigration variables, not language barriers, affect diabetes complications
Language barriers do not appear to increase the risk for diabetes complications in a heterogeneous immigrant population with universal health insurance, according to research published in Diabetes Care.
However, diabetes complications could vary depending on an immigrant’s age at landing, education level, marital status and neighborhood of settlement, Canadian researchers found.
“Immigrants with language barriers have higher rates of acute and chronic complications of diabetes, including death. However, these higher rates are largely attributed to baseline differences,” the researchers wrote. “Immigrants who are older, unmarried, less educated, who arrive through family reunification or as refugees, and who settle in rural neighborhoods appear to be at a higher risk of complications from diabetes.”
Karen Okrainec, MD, of the University Health Network in Toronto, and colleagues from other institutions identified through linked health and immigration databases 87,707 adults with diabetes who immigrated to Ontario, Canada, between 1985 and 2005. The data were stratified by language ability at the time of immigration application, and the average follow-up was 6.9 person-years.
As the primary endpoint, the investigators looked for at least one ED visit or hospitalization among two categories: hypo- or hyperglycemia, skin and soft tissue infection or foot ulcer; or a cardiovascular event or death between April 1, 2005, and Feb. 29, 2012.
Immigrants with language barriers were older (mean age, 49 ± 15 vs. 42 ± 13 years; P < .001), more inclined to have immigrated to reunite family (66% vs. 38%; P < .001), less educated (secondary school or less and no education, 82% vs. 53%; P < .001) and more frequent health care consumers (mean visits, 8.6 ± 12.1 vs. 7.8 ± 11.2; P < .001).
Immigrants with language barriers did not demonstrate higher adjusted rates for acute complications (HR = 0.99; 95% CI, 0.93-1.05) or CV events or death (HR = 0.95; 95% CI, 0.91-0.99). Older age, being unmarried, residing in a rural neighborhood and having less education predicted complications.
Immigrants aged 65 years or older who arrived through family reunification demonstrated lower risk for CV events or death (HR = 0.88; 95% CI, 0.81-0.96).
“The effect of language barriers on complications among immigrants with diabetes cannot be studied independently of other pre- and post-migration variables,” the researchers wrote. “Further research is needed to better understand how social isolation may affect transitions for immigrants and, ultimately, health outcomes.” – by Allegra Tiver
Disclosure: The researchers report no relevant financial disclosures.