Parent-child correlation was observed in 46.5% of 70,702 diabetes-related deaths in Puerto Rico, demonstrating significant intergenerational transmission of mortality risk.
Observational (n=70,702)
Diabetes mortality in Puerto Rico shows strong intergenerational transmission, highlighting the need for family-centered interventions.
Background: Diabetes mellitus continues to be a major public-health concern in Puerto Rico, with mortality rates rising steadily over the past four decades (Geiss et al., 2012). Beyond biomedical determinants, this condition reflects a complex interaction of genetic predisposition, behavioral patterns, and social inequities. Grounded in Engel's (1977) biopsychosocial model, this study examines diabetes mortality through both hereditary and cultural lenses, highlighting how family environments transmit risk across generations. Objective: The study investigates intergenerational diabetes-related mortality in Puerto Rico from 1980 to 2024, analyzing genetic and behavioral determinants, as well as the equity gaps that perpetuate family-level vulnerability. Methods: A quantitative retrospective analysis was conducted using 70,702 official death records from the Puerto Rico Department of Health. Familial linkages were established through parent-child identifiers. Binary logistic regression and decision-tree modeling were applied to estimate mortality probability, controlling for age, sex, body mass index, and healthcare access. The analytic approach integrates clinical, family, and social variables to test Engel's biopsychosocial framework. Results: Nearly half (46.5%) of diabetes-related deaths exhibited a parent-child correlation. Of these, 15.7% involved both parents, 18.2% father-only, and 12.7% mother-only. Unspecified diabetes represented 41.7% of cases. entConclusion: This study demonstrates that diabetes mortality in Puerto Rico is both biologically and socially transmitted across generations. Consistent with Engel's model and recent public-health evidence (Johnson et al., 2017; Sánchez & Padilla Vega, 2025), it calls for culturally adapted, family-centered interventions that integrate early screening, nutrition counseling, and equitable healthcare access to disrupt the intergenerational cycle of diabetes.
Sánchez et al. (Sun,) conducted a observational in Diabetes mellitus (n=70,702). Parent-child correlation was observed in 46.5% of 70,702 diabetes-related deaths in Puerto Rico, demonstrating significant intergenerational transmission of mortality risk.