Author ORCID Identifier
https://orcid.org/0000-0003-2474-4816
Defense Date
2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Healthcare Policy & Research
First Advisor
Peter J Cunningham, PhD
Abstract
Introduction: Type 2 diabetes (T2D) disproportionately affects U.S. Hispanic populations. This dissertation examined whether structural determinants fundamentally drive T2D disparities among Hispanics, with attention to within-group racial heterogeneity.
Methods: Three studies utilized nationally representative data. Study 1 examined neighborhood segregation and ethnic enclave residence associations with T2D using restricted NHANES data (2011-2018, n=5,056). Study 2 investigated acculturation and T2D associations using restricted NHANES data (2011-2018, n=4,540). Study 3 analyzed patient-provider racial/ethnic concordance and adequate diabetes care using MEPS data (2008-2021, n=17,138).
Results: Structural factors demonstrated primacy across all studies. Neighborhood segregation (aOR=1.17, p>0.05) and ethnic enclave residence showed no association with T2D after controlling for individual factors. Acculturation-T2D associations were fully attenuated by socioeconomic factors (aOR=1.13, 95% CI: 0.79-1.62). Patient-provider concordance showed no association with composite adequate care (aOR=0.97, 95% CI: 0.83-1.13), though process-specific benefits were found for minorities. Non-White Hispanics consistently demonstrated lower education (43.6% vs. 28.9%
Discussion: Evidence indicates structural factors such as education, income, and healthcare access, drive T2D disparities among Hispanics. Findings reveal how U.S. racial hierarchies reflect differential exposure and vulnerability within ethnic groups. Achieving T2D equity requires addressing root caus
Rights
Copyright © 2025 Danielle Renee Montoya
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
12-2-2025