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Breaking down racial disparities in diabetes prevalence
Person checking blood sugar level with glucometer.
Diabetes is a disease about which there are countless myths, misconceptions and even moral judgments. Widespread cultural beliefs about who develops diabetes, as well as how and why, contribute to stigma and shame around the disease while obscuring its real and very worrying social determinants.
For many, diabetes, particularly type 2, is associated with poor decision-making: it is seen as a consequence of an unhealthy diet and lifestyle, and is therefore different from other chronic diseases such as cancer. or Crohn’s disease. Others may view diabetes as a product of body fat or even as a disease specific to the biology of certain racial or ethnic groups.
The stigma of diabetes is pervasive. two studies published in 2020 in association with the Rudd Center for Food Policy and Health at the University of Connecticut, found that this is the case not only socially but also within medical settings. In one study, 53% of surveyed adults with type 2 diabetes believed they might have prevented from developing the conditionand nearly 1 in 2 experienced judgment over their dietary choices and felt the need to hide their condition from others.
A second study showed that 44% of diabetic adults felt judged by your health care provider for his weight and condition. in a previous study from 2017 of people with type 1 or type 2 diabetes, 81% of those who reported stigma indicated they felt they had a character flaw or that having diabetes was a “lack of personal responsibility.”
However, medical researchers have debunked factors such as individual choice, body fateither ethnic biology as the driving forces behind diabetes. Instead, disease is one of many health conditions that expose Existing health disparities related to race and class. The impacts of social inequalities, including the conditions created by systemic racism and poverty, such as access to quality and affordable health care, nutritious food, and a clean environment, as well as other factors such as background relatives, strongly influences diabetes rates.
These inequities continue to affect the treatment of those who have already been diagnosed with diabetes as well. The price of insulin in the US has Exploded by more than 600% in the last two decades, far exceeding inflation rates. Reports have accused pharmaceutical companies of Take advantage from the fact that insulin is a drug that saves the lives of millions of people, knowing that it will probably be bought at any cost.
The rising cost of insulin disproportionately affects low-income and uninsured populations, putting them at greater risk of dangerous complications and death. The Inflation Reduction Act capped insulin copays for Medicare subscribers at $35, but set no limit for Medicaid, employer-provided or individually purchased insurance coverage.
Using data from the Centers for Disease Control and Prevention and world Bank, Northwell Health analyzed racial disparities in the prevalence and morbidity of diabetes in the US Both type 1 and type 2 diabetes were included in the data, but since type 2 is much more commonmost of the trends represented in the analysis reflect rates of type 2 diabetes.
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Diabetes Rates in the US
Line graph showing the rate of diabetes in the US between 2000 and 2021. It has increased across the board, with Black and Hispanic people having the highest rates.
United States has one of the highest rates of diabetes in the world, but the disease does not affect the population uniformly. According to the CDC, African American and Hispanic populations experience much higher rates of diabetes than white populations; Asian populations have diabetes rates just above the US average.
Native Americans also experience disproportionately high rates of diabetes, according to data from the Indian Health Service. Up to 14.5% of American Indian and Alaska Native populations had diabetes in 2018-19, the highest rates of diabetes of any racial or ethnic group.
Studies of racial disparities in diabetes rates have shown that a variety of economic, social, and geographic factors are linked to systemic racism. impact on diabetes prevalence. According to the American Journal of Public Health, poverty, high exposure to toxins, limited access to affordable nutritious food, and inaccessible health care services are just a few of the risk factors that have been shown to raise the risk of diabetes. risk factors that Black and other non-white Americans experience at disproportionate rates.
Despite the higher rates of the disease among non-white populations, these populations are not always considered in clinical trials for treatment. A 2017 analysis of diabetes treatment evidence revealed that of 19 individually tested drugs, only four were tested in black, latino, and Asian populations (the others were selectively tested among those populations, but not in each of them), despite the fact that these groups represent a large percentage of those with diabetes in the US. Participation of Native Americans in clinical trials for the treatment of diabetes was not included in the analysis.
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regional disparities
County map showing the southern US, especially South Carolina, Mississippi, and Alabama, which have the highest prevalence of diabetes.
Diabetes rates are particularly high in the Appalachian and Southeastern regions of the US, a group the CDC called the “diabetes belt” in 2015. Determined using county-level data, regions were included in the diabetes belt if at least 11% of residents were diagnosed with the disease. The disparity in diabetes rates in this region, which largely overlaps with the so-called “stroke belt,” reflects specific population concentrations: a most black Americans lives in the Carolinas, Georgia, Alabama, Mississippi and Louisiana, according to census data.
Perhaps unsurprisingly, many of the factors associated with a higher prevalence of diabetes are particularly concentrated in this region. Many of the counties with high rates of diabetes are rural, where accessing health care is more difficult due to long distances between residents and providers, limited public transportation, and lack of affordability. In addition, many states in the region have not adopted expanded access to Medicaidthat would cover more low-income people and offer an improved federal match rate, making affordable health care even less accessible.
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Disparities Among Pacific Islanders
Bar graph showing the prevalence of diabetes by territory compared to the US average of 10.7% in 2021. The American Pacific territories show the highest prevalence of diabetes. The Northern Mariana Islands had the highest rate of 23.4%.
Over the past few decades, the Pacific island nations have experienced some of the highest rates of diabetes in the world, and much higher rates than the mainland US. But this has not always been the case: studies have shown that the colonization of the islands had a seismic impact on health outcomesas well as economic and social well-being.
Before Japanese, Spanish, American, and German forces occupied the Pacific islands, the indigenous inhabitants of the Pacific islands ate primarily native staples such as taro, breadfruit, yams, and cassava. The arrival of the colonizing powers meant the substitution of many of these foods with highly processed foods and different types of starches, which caused a fundamental change in the general diet.
Added to the influx of less nutritious foods into Pacific island nations was the intentional sale of non-nutritious (but affordable) food waste, such as turkey tailsfrom the US to the islands, allowing US industries to profit while causing enough health problems that American Samoa banned imports of turkey tail in 2007. These profound changes in the diet helped catalyze a rapid rise in diabetes in a population that previously had very low rates of the disease.
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Mortality disparities
Column chart showing diabetes death rates for Native Americans and US Blacks are well above the national average.
In 2021, diabetes was the eighth leading cause of death In the US, American Indians, Alaska Natives, and African Americans have disproportionately high diabetes death rates compared to the national average. Diabetes is not usually a fatal disease, as long as it is treated and monitored carefully. However, it can become a fatal disease if left untreated and can also lead to complications such as heart disease and increased risk of stroke.
Studies have shown that diabetes mortality is influenced by the same risk factors that put black and Native Americans at the highest risk of diabetes in the first place: segregation, conditions of poverty created by systemic racism, and lack of access to affordable health care. For those who do not have equitable access to affordable treatment and medical management of potential complications, diabetes is more likely to become fatal.
This story originally appeared on Northwell Health and was produced and
distributed in association with Stacker Studio.
