Diabetes and acculturation in African immigrants to the United States: analysis of the 2010-2017 National Health Interview Survey (NHIS)

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 ( = 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.