Advertisement

Sex Differences in Factors Contributing to the Racial Disparity in Diabetes Risk

Published:December 02, 2020DOI:https://doi.org/10.1016/j.amepre.2020.09.016

      Introduction

      Diabetes incidence differs by race in the U.S., with a persistent reported Black–White disparity. However, the factors that contribute to this excess risk in middle-aged and older adults are unclear.

      Methods

      This prospective cohort study included 7,171 Black and White adults aged ≥45 years without diabetes at baseline (2003‒2007) who completed a follow-up examination (2013‒2016). Modified Poisson regression was used to obtain sex-stratified RRs for diabetes. Mediation analyses using a change in β coefficient assessed individual and neighborhood factors that contribute to the racial disparity in diabetes incidence. Statistical analyses were conducted in 2018–2019.

      Results

      The cumulative incidence of diabetes was higher for Black men (16.2%) and women (17.7%) than for White men (11.0%) and women (8.1%). Adjusting for age and prediabetes, diabetes risk was higher for Black women than for White women (RR=1.75, 95% CI=1.47, 2.07) and for Black men than for White men (RR=1.33, 95% CI=1.09, 1.64). The individual factors that attenuated the racial disparity the most were Southern dietary pattern (change in β=42.8%) and neighborhood socioeconomic environment (change in β=26.3%) among men and BMI (change in β=34.4%) and waist circumference (change in β=32.4%) among women. When including all factors collectively, the racial disparity in diabetes incidence was similar for men (RR=1.38, 95% CI=1.04, 1.83) and was attenuated for women (RR=1.41, 95% CI=1.11, 1.81).

      Conclusions

      The racial disparity in diabetes incidence remained after accounting for individual and neighborhood factors. Further investigation of additional factors underlying this racial disparity is needed to inform multilevel strategies for diabetes prevention.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Bancks MP
        • Kershaw K
        • Carson AP
        • Gordon-Larsen P
        • Schreiner PJ
        • Carnethon MR
        Association of modifiable risk factors in young adulthood with racial disparity in incident type 2 diabetes during middle adulthood.
        JAMA. 2017; 318: 2457-2465
        • Brancati FL
        • Kao WH
        • Folsom AR
        • Watson RL
        • Szklo M
        Incident type 2 diabetes mellitus in African American and White adults: the Atherosclerosis Risk in Communities study.
        JAMA. 2000; 283: 2253-2259
        • Howard G
        • Safford MM
        • Moy CS
        • et al.
        Racial differences in the incidence of cardiovascular risk factors in older Black and White adults.
        J Am Geriatr Soc. 2017; 65: 83-90
        • McBean AM
        • Li S
        • Gilbertson DT
        • Collins AJ
        Differences in diabetes prevalence, incidence, and mortality among the elderly of four racial/ethnic groups: whites, Blacks, Hispanics, and Asians.
        Diabetes Care. 2004; 27: 2317-2324
        • Geiss LS
        • Wang J
        • Cheng YJ
        • et al.
        Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980-2012.
        JAMA. 2014; 312: 1218-1226
        • Chatterjee R
        • Brancati FL
        • Shafi T
        • et al.
        Non-traditional risk factors are important contributors to the racial disparity in diabetes risk: the Atherosclerosis Risk in Communities study.
        J Gen Intern Med. 2014; 29: 290-297
        • Kulick ER
        • Moon YP
        • Cheung K
        • Willey JZ
        • Sacco RL
        • Elkind MS
        Racial-ethnic disparities in the association between risk factors and diabetes: the Northern Manhattan Study.
        Prev Med. 2016; 83: 31-36
        • Quiñones AR
        • Liang J
        • Ye W
        Differences in diabetes mellitus onset for older Black, White, and Mexican Americans.
        Ethn Dis. 2013; 23: 310-315
        • Howard VJ
        • Cushman M
        • Pulley L
        • et al.
        The reasons for geographic and racial differences in stroke study: objectives and design.
        Neuroepidemiology. 2005; 25: 135-143
        • Judd SE
        • Letter AJ
        • Shikany JM
        • Roth DL
        • Newby PK
        Dietary patterns derived using exploratory and confirmatory factor analysis are stable and generalizable across race, region, and gender subgroups in the REGARDS study.
        Front Nutr. 2014; 1: 29
        • Tsivgoulis G
        • Judd S
        • Letter AJ
        • et al.
        Adherence to a Mediterranean diet and risk of incident cognitive impairment.
        Neurology. 2013; 80: 1684-1692
        • Diez Roux AV
        • Merkin SS
        • Arnett D
        • et al.
        Neighborhood of residence and incidence of coronary heart disease.
        N Engl J Med. 2001; 345: 99-106
        • Melchior LA
        • Huba GJ
        • Brown VB
        • Reback CJ
        A short depression index for women.
        Educ Psychol Meas. 1993; 53: 1117-1125
        • Cohen S
        • Kamarck T
        • Mermelstein R
        A global measure of perceived stress.
        J Health Soc Behav. 1983; 24: 385-396
        • Ware Jr, J
        • Kosinski M
        • Keller SD
        A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • Gillett SR
        • Boyle RH
        • Zakai NA
        • McClure LA
        • Jenny NS
        • Cushman M
        Validating laboratory results in a national observational cohort study without field centers: the Reasons for Geographic and Racial Differences in Stroke cohort.
        Clin Biochem. 2014; 47: 243-246
        • Levey AS
        • Stevens LA
        • Schmid CH
        • et al.
        A new equation to estimate glomerular filtration rate [published correction appears in Ann Intern Med. 2011;155(6):408].
        Ann Intern Med. 2009; 150: 604-612
        • Zou G
        A modified Poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004; 159: 702-706
        • Long DL
        • Howard G
        • Long DM
        • et al.
        An investigation of selection bias in estimating racial disparity in stroke risk factors.
        Am J Epidemiol. 2019; 188: 587-597
        • Resnick HE
        • Valsania P
        • Halter JB
        • Lin X
        Differential effects of BMI on diabetes risk among black and white Americans.
        Diabetes Care. 1998; 21: 1828-1835
        • Joseph JJ
        • Bennett A
        • Echouffo Tcheugui JB
        • et al.
        Ideal cardiovascular health, glycaemic status and incident type 2 diabetes mellitus: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.
        Diabetologia. 2019; 62: 426-437
        • Lipton RB
        • Liao Y
        • Cao G
        • Cooper RS
        • McGee D
        Determinants of incident non-insulin-dependent diabetes mellitus among blacks and whites in a national sample. The NHANES I Epidemiologic Follow-up study [published correction appears in Am J Epidemiol. 1994;139(9):964].
        Am J Epidemiol. 1993; 138: 826-839
        • Knowler WC
        • Fowler SE
        • et al.
        • Diabetes Prevention Program Research Group
        10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes study [published correction appears in Lancet. 2009;374(9707):2054].
        Lancet. 2009; 374: 1677-1686
        • Alva ML
        • Hoerger TJ
        • Jeyaraman R
        • Amico P
        • Rojas-Smith L
        Impact of the YMCA of the USA Diabetes Prevention Program on Medicare spending and utilization.
        Health Aff (Millwood). 2017; 36: 417-424
        • Centers for Medicare & Medicaid Services (CMS)
        • HHS
        Medicare program; revisions to payment policies under the physician fee schedule and other revisions to part b for cy 2018; medicare shared savings program requirements; and medicare diabetes prevention program. Final rule.
        Fed Regist. 2017; 82 (Accessed October 30, 2020): 52976-53371
        • Menke A
        • Casagrande S
        • Geiss L
        • Cowie CC
        Prevalence of and trends in diabetes among adults in the United States, 1988-2012.
        JAMA. 2015; 314: 1021-1029
        • Fishman EI
        • Stokes A
        • Preston SH
        The dynamics of diabetes among birth cohorts in the U.S.
        Diabetes Care. 2014; 37: 1052-1059
        • Nichols GA
        • Schroeder EB
        • Karter AJ
        • et al.
        Trends in diabetes incidence among 7 million insured adults, 2006-2011: the SUPREME-DM project.
        Am J Epidemiol. 2015; 181: 32-39
        • Kirkman MS
        • Briscoe VJ
        • Clark N
        • et al.
        Diabetes in older adults: a consensus report.
        J Am Geriatr Soc. 2012; 60: 2342-2356
        • Lipska KJ
        • Ross JS
        • Miao Y
        • Shah ND
        • Lee SJ
        • Steinman MA
        Potential overtreatment of diabetes mellitus in older adults with tight glycemic control.
        JAMA Intern Med. 2015; 175: 356-362
        • American Diabetes Association
        11. Older adults: standards of medical care in Diabetes-2018.
        Diabetes Care. 2018; 41: S119-S125