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March 2004, Vol 94, No. 3 | American Journal of Public Health 434-437
© 2004 American Public Health Association

RESEARCH AND PRACTICE

Diabetes Prevalence Among Puerto Rican Adults in New York City, NY, 2000

Thomas A. Melnik, DrPH, Akiko S. Hosler, PhD, Jackson P. Sekhobo, MPA, Thomas P. Duffy, MA, Edward F. Tierney, MPH, Michael M. Engelgau, MD, MS and Linda S. Geiss, MA

Thomas A. Melnik, Akiko S. Hosler, and Jackson P. Sekhobo are with the Bureau of Chronic Disease Epidemiology and Surveillance, New York State Department of Health, Albany. Akiko S. Hosler is also with the Department of Epidemiology, University of Albany School of Public Health, Albany, NY. Thomas P. Duffy is with ORC Macro, New York, NY. Edward F. Tierney, Michael M. Engelgau, and Linda S. Geiss are with the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, Atlanta, Ga.

Correspondence: Requests for information should be sent to Thomas A. Melnik, DrPH, 565 Corning Tower, Empire State Plaza, Albany, NY 12237-0679 (e-mail: tmm02{at}health.state.ny.us).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION AND CONCLUSIONS
 References
 

This study assessed the prevalence of diagnosed diabetes and associated characteristics among Puerto Rican adults in New York City, NY, with a random-digit–dialed telephone survey with a dual-frame sampling design. Overall, 11.3% (95% confidence interval = 8.7%, 14.0%) had diagnosed diabetes; diabetes was significantly related to age, obesity, and family history; and the prevalence was high among those with the least education. This study showed the ability to obtain critically needed diabetes information from ethnic minorities at the local level.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION AND CONCLUSIONS
 References
 
Diabetes is a leading cause of mortality, morbidity, and disability that disproportionately affects US Hispanic persons.1 Reported diabetes prevalence among the US Hispanic population is approximately twice that of non-Hispanic Whites.2 Because the US Hispanic population is heterogeneous, diabetes risk is likely to vary according to the diverse ethnic origins.3,4 Puerto Rican persons are the largest Hispanic group in New York City, NY,5 and they are among the most assimilated Hispanic persons to the US culture.6 However, recent information about diabetes in this population is lacking.7,8 This study assessed the prevalence of diagnosed diabetes and associated characteristics among Puerto Rican adults in New York City.


   METHODS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION AND CONCLUSIONS
 References
 
Respondents were selected by using random-digit–dialed telephone survey methodology, which adhered closely to the Behavioral Risk Factor Surveillance System (BRFSS) protocol.9,10 A dual-frame sampling design was used to improve design efficiency and reduce costs. One frame sampled telephone exchanges in proportion to the number of Puerto Rican households within New York City census tracts. The other frame sampled New York City telephone numbers with associated Hispanic surnames.

The sample (N = 1304) included New York City residents aged 18 years and older who identified themselves as Puerto Rican as part of the interview to screen for study eligibility. Diagnosed diabetes was assessed by asking the standard BRFSS question: "Have you ever been told by a doctor that you have diabetes?" All respondents reporting diabetes were retained in the sample. Respondents without diabetes were selected at a rate to yield approximately equal numbers of respondents with and without diabetes in the final sample. The study questionnaire in both English and Spanish languages consisted primarily of BRFSS questions. Questions with respect to birthplace and language were added as indicators of US assimilation.11,12 Interviews were conducted from June 1999 through June 2000.

The data were weighted to reflect the probabilities of selection and were poststratified to the age and gender distribution of the New York City Puerto Rican population with the 1990 Integrated Public Use Microdata Series, the most recently available source of data.13 Diabetes prevalence was calculated with respect to several subject characteristics, and estimates were standardized to the overall age distribution in the population. SUDAAN software for complex survey design was used for variance estimation, age standardization, and statistical testing.14


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION AND CONCLUSIONS
 References
 
Puerto Rican adults in New York City were relatively young and were more likely to be female and of low socioeconomic status as indicated by low educational attainment and high rates of uninsured and Medicaid recipients (Table 1Go). More than half were born in the United States, and approximately 60% spoke English as the principal household language. The prevalence of overweight and obesity and family history of diabetes was high. A greater proportion of individuals with diagnosed diabetes were older, female, less educated, born in Puerto Rico, Spanish speaking, overweight or obese, and receiving Medicaid and had a family history of the disease.


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  		TABLE 1— Sociodemographic and Health-Related Characteristics of Puerto Rican Adults in New York City, 2000
 
Overall, 11.3% (95% confidence interval = 8.7%, 14.0%) had diagnosed diabetes (Table 2Go). Diabetes prevalence increased with age and was higher among those with less education, born in Puerto Rico, living in Spanish-speaking households, with obesity, and with a family history of diabetes. Following age adjustment, diabetes was significantly higher among the obese persons and those with a family history of diabetes. These remained significant when modeled with the other factors.


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  		TABLE 2— Prevalence of Diagnosed Diabetes Among Puerto Rican Adults in New York City, by Sociodemographic and Health-Related Characteristics, 2000
 

   DISCUSSION AND CONCLUSIONS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION AND CONCLUSIONS
References
 
The findings in this report indicate a high prevalence of diagnosed diabetes among Puerto Rican adults in New York City. The prevalence of 11.3% reported here is higher than that recently reported for the US Hispanic population (8.0%) and the native Puerto Rican population (9.6%).2,15 A diagnosed diabetes prevalence of 35.2% (data not shown) for those aged 60 years and older in this study is similar to the 34.3% reported for Puerto Rican persons at that age in Massachusetts.16 Applying the ratio of undiagnosed-to-total diabetes cases of 35%, the total diabetes prevalence approaches 15%.17 This compares to a reported total diabetes prevalence of 13.4% for New York City–area Puerto Rican persons aged 18 to 74 years from the 1982 to 1984 Hispanic Health and Nutrition Examination Survey.8

Diabetes was significantly related to age, obesity, and family history of diabetes and was high among those with the least education. The effect of birthplace and language moderated substantially and became nonsignificant after age adjustment. Diabetes in this population, therefore, is related to factors typically associated with the disease in the United States.8

The limitations of this study include underestimated prevalence because diabetes is frequently undiagnosed.7 Second, estimates obtained from telephone surveys also may be biased because of relatively low response rates and underestimated in populations with low telephone coverage.18 However, the response (45.1%) and cooperation rates (62.8%) from this survey of inner-city minorities were higher than in the statewide 2000 New York State BRFSS (32.9% and 34.7%, respectively).19,20 Moreover, the Centers for Disease Control and Prevention has reported that bias in BRFSS data was not associated with response rates.21 Finally, 1990 Integrated Public Use Microdata Series data may not accurately reflect the current population. As a verification measure, Puerto Rican origin and birthplace of the poststratified adult sample were compared with findings for all Puerto Rican people in New York City from the 2000 census by county, and no significant differences were found.22,23

Eliminating health disparities and reducing the burden of diabetes in Hispanic communities are major goals for the nation and New York State. The findings will be used to strengthen New York’s existing program efforts to create targeted initiatives to reduce the burden of diabetes in Puerto Rican and other Hispanic communities. This survey further shows the ability to obtain critically needed diabetes information at the local level from an urban minority population defined by ethnic origin. Similar approaches can be applied by other states and localities to better understand the extent and distribution of diabetes and risk factors in defined population groups.


   Acknowledgments
 
This research was supported by funding from the Association of Schools of Public Health project (S0742-18/19).

Human Participant Protection
The New York State Department of Health institutional review board approved the project as an exemption.


   Footnotes
 
Contributors
T. A. Melnik and A. S. Hosler contributed to all aspects of the study, including the conception and design of the study, analysis and interpretation of the data, and drafting and finalizing of the content of the brief. J. P. Sekhobo contributed to the analysis and interpretation of the data and to the drafting and finalizing of the brief. T. P. Duffy contributed to the conception and design of the study and to the finalizing of the brief. E. F. Tierney, M. M. Engelgau, and L. S. Geiss each contributed to the design of the study, interpretation and discussion of the results, and finalizing of the brief.

Peer Reviewed

Accepted for publication August 20, 2003.


   References
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION AND CONCLUSIONS
 References
 
1. Stern MP, Mitchell BD. Diabetes in Hispanic Americans. In: Harris MI, Cowie CC, Stern MP, Boyko EJ, Reiber GE, Bennet PH, eds. Diabetes in America. 2nd ed. Washington, DC: US Dept of Health and Human Services, National Institutes of Health; 1995:631–659. DHHS publication NIH 95-1468.

2. Centers for Disease Control and Prevention. Self-reported prevalence of diabetes among Hispanics—United States, 1994–1997. MMWR Morb Mortal Wkly Rep. 1999;48:8–12.[Medline]

3. Harris CL, Hewett-Emmett D, Bertin TK, Schull WJ. Origins of U.S. Hispanics: implications for diabetes. Diabetes Care. 1991;14(suppl):618–627.[Abstract]

4. del Pinal JH. Hispanic Americans in the United States: young, dynamic, and diverse. Stat Bull Metropolitan Insurance Co. 1996;77:2–13.

5. US Census Bureau. American FactFinder. Available at: http://factfinder.census.gov. Accessed June 30, 2003.

6. Portes A, Rumbaut RG. Immigrant America: A Portrait. 2nd ed. Berkeley: University of California Press; 1996.

7. Flegal KM, Ezzati TM, Harris MI, et al. Prevalence of diabetes in Mexican Americans, Cubans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982–1984. Diabetes Care. 1991;14:628–638.[Abstract]

8. Harris MI. Epidemiological correlates of NIDDM in Hispanics, whites, and blacks in the US population. Diabetes Care. 1991;14:639–648.[Abstract]

9. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM, Hogelin GC. Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981–87. Public Health Rep. 1988;103:366–375.[ISI][Medline]

10. Behavioral Risk Factor Surveillance System User’s Guide. Atlanta, Ga: Centers for Disease Control and Prevention; 1999.

11. Gordon MM.Assimilation in American Life. New York, NY: Oxford University Press; 1964.

12. Hosler AS. Assimilation. In: Hoser AS, ed. Japanese Immigrant Entrepreneurs in New York City: A New Wave of Ethnic Business. New York, NY: Garland Publishing; 1998:163–197.

13. Ruggles S, Sobek M, Fitch CA, Hall PK, Ronnander C. Integrated Public Use Microdata Series: Version 2.0. Minneapolis: Historical Census Projects, University of Minnesota; 1997.

14. Shah BV, Barnwell BG, Bieler GS. SUDAAN User’s Manual. Release 7.5. Research Triangle Park, NC: Research Triangle Institute; 1997.

15. Perez-Cardonna C, Perez-Perdomo R. Prevalence and associated factors of diabetes mellitus in Puerto Rican adults: Behavioral Risk Factor Surveillance System, 1999. P R Health Sci J. 2001;20:147–155.[Medline]

16. Tucker KL, Bermudez OI, Castaneda C. Type 2 diabetes is prevalent and poorly controlled among Hispanic elders of Caribbean origin. Am J Public Health. 2000;90:1288–1293.[Abstract/Free Full Text]

17. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2000. Atlanta, Ga: Centers for Disease Control and Prevention; 2002.

18. Ford ES. Characteristics of survey participants with and without a telephone: findings from the Third National Health and Nutrition Examination Survey. J Clin Epidemiol. 1998;51:55–60.[ISI][Medline]

19. 1999–2000 Diabetes Surveillance of Puerto Rican Adult Population in New York City: Technical Report. New York, NY: ORC Macro; 2002.

20. 2000 BRFSS Summary Data Quality Report. Atlanta, Ga: Centers for Disease Control and Prevention; 2001.

21. Centers for Disease Control and Prevention. Public health surveillance for behavioral risk factors in a changing environment: recommendations from the Behavioral Risk Factor Surveillance Team. MMWR Morb Mortal Wkly Rep. 2003;52(RR-9):6.

22. US Census Bureau. American FactFinder. Table PCT11: Hispanic or Latino by specific origin. Available at: http://factfinder.census.gov/servlet/BasicFactsServlet. Accessed October 30, 2002.

23. US Census Bureau. American FactFinder. Table P21: Place of birth by citizenship status. Available at: http://factfinder.census.gov/servlet/BasicFactsServlet. Accessed October 30, 2002.




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This Article
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Right arrow Articles by Melnik, T. A.
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Related Collections
Right arrow Obesity, Overweight, Underweight
Right arrow Diabetes
Right arrow Hispanics/Latinos
Right arrow Socioeconomic Factors
Right arrow Surveys
Right arrow Urban Health

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