Examination of Marshallese Living in US Illustrates Health Disparities in T2D

A study of Marshall Islanders living in Arkansas and Oklahoma participating in a Diabetes Prevention Program showed a high proportion of undiagnosed hypertension and type 2 diabetes (T2D).

With 10,000 residents, Arkansas has the largest population of Marshallese in the continental United States. With hypertension and T2D disproportionately affecting minorities—including Native Hawaiian and Pacific Islander (NHPI) populations and Marshallese in particular—researchers from the University of Arkansas sought to examine the prevalence of both diagnosed and undiagnosed hypertension and T2D in the Marshallese population.

The study, in the Yale Journal of Biology and Medicine, of 378 overweight/obese Marshallese Pacific Islander adults found that 68.4% with blood readings indicative of hypertension were undiagnosed. Among participants with glycated hemoglobin (HbA1c) levels indicative of T2D, 31.6% were undiagnosed.

The study also found that that undiagnosed hypertension was significantly associated with age (P <.001) and sex (P = .028), but not with foregone health care due to cost, health insurance coverage, or body mass index (BMI).

Undiagnosed T2D was significantly associated with age (P <.05), foregone care due to cost (P = .018), health insurance status (P = .035), and BMI (P = .001) but not sex.

Among those with blood pressure readings indicative of hypertension, young adults aged 18 to 34 years were more than 3 times as likely to be undiagnosed as middle-aged adults aged 35 to 54 and 18 times as likely to be undiagnosed as older adults age 55 and older. Middle-aged adults were 5 times as likely to be undiagnosed as older adults and males were twice as likely to be undiagnosed as females.

Among those with HbA1c readings indicative of T2D, young adults had statistically equal odds of being undiagnosed as middle-aged adults (odds ratio [OR], 1.67; 95% CI, 0.61-4.95) but were over 5 times as likely to be undiagnosed as older adults (OR, 5.50; 95% CI, 1.54- 19.58). Middle-aged adults were over 3 times as likely to be undiagnosed as older adults (OR, 3.29; 95% CI, 1.20-9.01).

Participants who were unable to receive health care due to cost were less than half as likely to be undiagnosed as those who had no cost barrier to care (OR, 0.39; 95% CI, 0.18- 0.85). Uninsured participants were more than twice as likely to be undiagnosed as those with insurance (OR, 2.31; 95% CI, 1.06-5.04).

Participants who were obese were more than 5 times as likely to be undiagnosed as those who were overweight (OR; 5.51; 95% CI, 2.05-14.79).

Findings suggested the need for outreach to Marshallese to seek healthcare.

Previous studies have shown Marshallese to be hindered by language barriers, lack of understanding how to navigate the healthcare system, and concerns about being stigmatized. They also had been excluded from Medicaid, but coverage was reinstated as part of the December 2020 pandemic relief bill.

Across the United States, over 100 million (46.0%) adults aged 20 and older have hypertension, with rates even higher among minorities, leaving them vulnerable to cardiovascular disease, heart attack, stroke, and aneurysm. The 2011-2014 National Health and Nutrition Examination Survey showed 15.9% of US adults were undiagnosed. Percentages were higher for non-Hispanic Asians (24.7%) and Hispanics (20.2%) than non-Hispanic whites (14.9%). Minorities also have higher rates of T2D.

Reference

McElfish PA, Scott AJ, Chatrathi HE, et al. Undiagnosed hypertension and undiagnosed type 2 diabetes among overweight and obese Marshallese participants in a diabetes prevention program. Yale J Biol Med. 2021;94(1):5-12. Published online March 31, 2021.