Primary Submission Category: Structural factors
The impact of sanctuary policies on receipt of care among adult immigrants with diabetes living in the US
Authors: Danielle Crookes Wanjiang Wang Salome Goglichidze Tarik Benmarhnia Jennifer Lucas David Ezekiel-Herrera Maria-Elena De Trinidad Young Miguel Marino John Heintzman
Presenting Author: Danielle Crookes*
Immigrants of color experience a worsening of their cardiometabolic health with longer duration of residence in the US and have lower rates of preventive and disease management care use than the US-born. This is detrimental for disease progression among persons with diabetes. Federal immigration enforcement practices contribute to poorer healthcare access and health by increasing fear and isolation and decreasing mobility in the community. Sanctuary policies that mitigate the effects of federal enforcement in immigrant communities may improve immigrants’ healthcare use. This study examines associations between 2017 county-level sanctuary policies and the receipt of recommended diabetes monitoring care among immigrant and non-immigrant patients in OCHIN, a network of community health centers across the US.
This study uses electronic health record (EHR) data from 18+ year old patients (n = 19,526) diagnosed with diabetes who were seen at OCHIN community health centers from 2012-2019. Eligible patients had to have EHR-recorded race/ethnicity, country of birth, and address. The exposure is county-level sanctuary policies in place in 2017 based on seven policies measured by the Immigrant Legal Resource Center. Policy exposure is based on patients’ EHR-recorded county of residence in 2017. The outcomes are patients’ receipt of four CDC-recommended diabetes monitoring care components: at least two HbA1c tests, two visits with a health provider, one cholesterol test, and one kidney test each year.
The study uses a difference-in-difference-in-difference analysis to examine differences in receipt of care between foreign and US-born patients before (2012-2014) and after (2018-2019) sanctuary policy adoption and between counties with greater and fewer policies in place. Findings from this study provide some of the first evidence regarding associations between sanctuary policies and receipt of on-going diabetes monitoring care among immigrant adults in the US.