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Note: This chapter deals with culturally responsive care and patient safety. Because not all Black patients identify as African Americans, the authors have elected to use the term Black in this chapter as inclusive of African Americans as well as those individuals who are of African descent but may be from another country. The authors have also elected to use the term Latino/a when referring to individuals of "Hispanic" descent realizing that many individuals identify strongly with their country of origin. We understand the sensitivity of this terminology and ask your understanding.

CASE 29.1

You are doing a locum tenens job in Arizona on the Navajo reservation. You are seeing a lot of patients with diabetes, which reminds you that Native Americans, Latinos, and Blacks all have a greater incidence of diabetes compared to the general U.S. population.

Question 29.1.1 Which of the following is TRUE about the age-adjusted incidence of diabetes in adults?

A) All Alaska Native and Native American tribes have a higher incidence of diabetes than non-Hispanic Whites (NHW).

B) Cuban Americans and South Americans have a higher incidence of diabetes than NHW.

C) Mexican Americans and Puerto Ricans have close to 90% higher incidence of diabetes than NHW.

D) Pima Indians in Mexico have the same high incidence of diabetes as the Pima Indians in Arizona.

E) Non-Hispanic Blacks have a lower incidence of diabetes than Latinos in the United States.

Answer 29.1.1 The correct answer is "C." Mexican Americans and Puerto Ricans have a higher incidence of diabetes compared with NHW ("non-Hispanic White" being the term used by the U.S. Census Bureau). The other statements are false, and here's how they break down. Although their diabetes incidence is increasing rapidly, Alaska Natives historically had a 5.5% age-adjusted incidence of diabetes compared with 7.1% for NHW. Cubans and South Americans actually have the same incidence as NHW. The Pima Indians in Mexico whose lifestyle is not sedentary and who eat a more traditional diet actually have a diabetes incidence of about 7%, while those in Arizona have an incidence of 38%. Non-Hispanic Blacks have an incidence higher than those of Latinos and NHW but not quite as high as the Mexican Americans and Puerto Ricans.


Ethnic and cultural groups are not uniform from an epidemiological or cultural belief standpoint. Hence, there are often large differences between individuals and subgroups. This is complicated further by the fact that we all belong to, and are influenced by, multiple different cultural groups. Although there are cultural patterns within healthcare, try not to adopt those patterns as stereotypes for the individuals ...

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