title: Diabetes screening among immigrants: a population-based urban cohort study.
abstract: OBJECTIVE
  To examine diabetes screening, predictors of screening, and the burden of undiagnosed diabetes in the immigrant population and whether these estimates differ by ethnicity.
  
  
  METHODS
  A population-based retrospective cohort linking administrative health data to immigration files was used to follow the entire diabetes-free population aged 40 years and up in Ontario, Canada (N = 3,484,222) for 3 years (2004-2007) to determine whether individuals were screened for diabetes. Multivariate regression was used to determine predictors of having a diabetes test.
  
  
  RESULTS
  Screening rates were slightly higher in the immigrant versus the general population (76.0 and 74.4%, respectively; P < 0.001), with the highest rates in people born in South Asia, Mexico, Latin America, and the Caribbean. Immigrant seniors (age ≥65 years) were screened less than nonimmigrant seniors. Percent yield of new diabetes subjects among those screened was high for certain countries of birth (South Asia, 13.0%; Mexico and Latin America, 12.1%; Caribbean, 9.5%) and low among others (Europe, Central Asia, U.S., 5.1-5.2%). The number of physician visits was the single most important predictor of screening, and many high-risk ethnic groups required numerous visits before a test was administered. The proportion of diabetes that remained undiagnosed was estimated to be 9.7% in the general population and 9.0% in immigrants.
  
  
  CONCLUSIONS
  Overall diabetes-screening rates are high in Canada's universal health care setting, including among high-risk ethnic groups. Despite this finding, disparities in screening rates between immigrant subgroups persist and multiple physician visits are often required to achieve recommended screening levels.
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada. creatorem@smh.ca
authors.forename: Maria I
authors.initials: MI
authors.lastname: Creatore
authors.forename: Gillian L
authors.initials: GL
authors.lastname: Booth
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D014505:Urban Population / Q000706:statistics & numerical data*