ABSTRACT

Objective: This study sought to assess the association between unidimensional acculturation and diabetes, and analyze mediating pathways of the association in African immigrants to the United States (U.S.).

Hypothesis: Acculturation would be positively associated with diabetes and that BMI (Body mass index), physical activity, and psychological distress would mediate this association.

Methods: An analysis of cross-sectional data from the 2010–2017 National Health Interview Surveys was performed. Adults aged ≥ 18 years who were born in Africa (African immigrants) and residing in the U.S. were considered. The outcome was self-reported diabetes, and acculturation was defined by percent of life spent in the U.S. and citizenship. Multivariable logistic regression analysis was used to assess the association between acculturation and diabetes, and mediation analysis was used to examine the mediating effects of BMI, physical activity, and psychological distress on this association.

Results: The analytic sample included 1648 African immigrants with mean (SD) age of 41.3 ± 0.45 years; 56.4% male. Additionally, 46% had ≥ college education, and 21.4% lived below the poverty threshold. About two-thirds were overweight/obese. Less than 50% exercised at adequate levels of physical activity levels. A small percentage (1.8%) reported psychological distress. The prevalence of self-reported diabetes was 6.1%, and 76.5% reported being acculturated. In the multivariate logistic regression analysis, higher levels of acculturation were associated with higher odds of diabetes diagnosis (Odds Ratio (OR) = 2.2; 95% CI = 1.1–4.4). Although BMI mediated the association between acculturation and diabetes (${\mathcal{Z}}_{\mathrm{M}\mathrm{e}\mathrm{d}\mathrm{i}\mathrm{a}\mathrm{t}\mathrm{i}\mathrm{o}\mathrm{n}}$ = 2.11, p = 0.036), only 18.9% of the total effect of acculturation on diabetes was explained by BMI.

Conclusions: Acculturation increased the odds of diabetes diagnosis, and BMI mediated the association. Thus, tailoring culturally-appropriate interventions to control BMI may contribute to preventing diabetes within African immigrant communities to the U.S.

摘要

目的：本研究旨在评估一维文化适应与糖尿病之间的关联，并分析非洲移民到美国 (US) 之间关联的中介途径。

假设：文化适应与糖尿病呈正相关，而 BMI（身体质量指数）、身体活动和心理困扰将调节这种关联。

方法：对 2010-2017 年全国健康访谈调查的横断面数据进行了分析。考虑了出生在非洲（非洲移民）并居住在美国的 18 岁以上的成年人。结果是自我报告的糖尿病，文化适应是由在美国和公民生活中度过的百分比定义的。多变量逻辑回归分析用于评估文化适应与糖尿病之间的关联，并使用中介分析来检验BMI、身体活动和心理困扰对这种关联的中介作用。

结果：分析样本包括 1648 名非洲移民，平均 (SD) 年龄为 41.3 ± 0.45 岁；56.4% 男性。此外，46% 的人具有 ≥ 大学学历，21.4% 的人生活在贫困线以下。大约三分之二的人超重/肥胖。不到 50% 的人在适当的体育活动水平下锻炼。一小部分（1.8%）报告了心理困扰。自我报告的糖尿病患病率为 6.1%，而 76.5% 的人报告接受了文化适应。在多变量逻辑回归分析中，更高水平的文化适应与更高的糖尿病诊断几率相关（优势比 (OR) = 2.2；95% CI = 1.1-4.4）。尽管 BMI 介导了文化适应与糖尿病之间的关联（${\mathcal{Z}}_{\mathrm{米}\mathrm{e}\mathrm{d}\mathrm{一世}\mathrm{一个}\mathrm{吨}\mathrm{一世}\mathrm{○}\mathrm{n}}$ = 2.11, p  = 0.036)，只有 18.9% 的文化适应对糖尿病的总影响是由 BMI 解释的。

结论：文化适应增加了糖尿病诊断的几率，而 BMI 介导了这种关联。因此，定制适合文化的干预措施来控制 BMI 可能有助于在非洲移民到美国的社区中预防糖尿病