Primary Submission Category: Migration
Differential associations between immigrant sanctuary policies and glucose-lowering medication prescription trends by type 2 diabetes severity
Authors: Danielle Crookes, Salome Goglichidze, Jennifer Lucas, Miguel Marino, John Heitzman,
Presenting Author: Danielle Crookes*
Immigration enforcement policies and activities have a detrimental effect on health care usage for immigrants and spillover effects on non-immigrants. The effects of sanctuary policies on mitigating those effects are understudied. Previous work has documented that sanctuary policies were not associated with receiving prescriptions for glucose-lowering medicines among immigrants and non-immigrants with type 2 diabetes, but it did not explore findings by disease severity. Patients who have uncontrolled blood sugar may be more likely to obtain prescriptions regardless of the policy environment. In this study, we used multilevel logistic regression to examine associations between county-level sanctuary policies that were in place in 2017 and patients’ receipt of prescriptions for glucose-lowering medications by patients’ recency of diagnosis, HbA1c level, and nativity status. Data included EHR-documented prescription records in a sample of 25,189 patients (18+ years old) (HbA1c always less than 7: n = 5,463, always between 7 and 9: n = 7,651, HbA1c ever more than 9: n = 12,075) seen at OCHIN clinics between 2017 and 2019. Higher odds of receiving at least one glucose-lowering medication prescription each year from 2017-2019 were observed in high sanctuary policy counties (3+ policies) compared with low sanctuary policies (0-2 policies) among newly diagnosed patients (diagnosed in 2017 or after) with HbA1c levels that were always less than 7 (adjusted OR: 2.2 (1.4-3.4)) or between 7 and 9 (aOR 1.4 (1.1-1.9)). No associations were observed between county policy status and receipt of prescriptions among newly diagnosed patients with HbA1c levels ever above 9 or patients with diabetes diagnosed prior to 2017 regardless of HbA1c levels. Most associations did not differ by nativity status. Sanctuary policies may be most influential in facilitating access to prescriptions for patients with type 2 diabetes who are newly diagnosed and when their disease state is less severe.