Diabetes: Exploring racial inequities

Diabetes: Exploring racial inequities

Written by Ana Sandoiu on November 13, 2020 — Fact checked by Zia Sherrell, MPH

The National Diabetes Statistics Report released by the Centers for Disease Control and Prevention (CDC) this year reveals stark racial disparities in the prevalence and incidence of diabetes across the United States.

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The 2020 National Diabetes Statistics report examines trends in diabetes incidence — that is, new cases of the condition — and prevalence — meaning existing cases of diabetes across the U.S. from 2008–2018.

The report makes no distinction between type 1 and type 2 diabetes, although it is worth noting that approximately 90–95% of adults with diabetes have type 2 diabetes.

Overall, the number of adults newly diagnosed with diabetes decreased in this decade. But, of the new cases, non-Hispanic Black adults and people of Hispanic descent made up the highest proportion.

Of the existing diagnosed cases, diabetes was most prevalent among American Indians/Alaska Natives (AI/AN), according to the report.

In this article, we explore these disparities in further detail, look for possible explanations, and examine the implications for health equity.

2020 Diabetes report: A racial breakdown

According to the new CDC report, more than 1 in 10 people in the U.S., around 34.2 million, live with diabetes, 34.1 million of whom are adults.

Of these, the paper estimates that 26.9 million have a diagnosis of the condition.

The “Prevalence of diagnosed diabetes was highest among American Indians/Alaska Natives (14.7%), people of Hispanic origin (12.5%), and non-Hispanic [Black Americans] (11.7%),” notes the report.

Non-Hispanic Asian Americans followed, with a prevalence of 9.2%, and non-Hispanic white Americans, with 7.5%. AI/AN women had a higher prevalence of diabetes than AI/AN men.

In terms of incidence, or new cases, the latest report recorded 1.5 million new cases of diabetes among U.S. adults in 2018. Of these, non-Hispanic Black adults had an incidence of 8.2 per 1,000 people, while those of Hispanic origin accounted for 9.7 per 1,000.

By comparison, the incidence for non-Hispanic white adults was 5.0 per 1,000 people.

These race-related health disparities are not new. A 2012 editorial by the American Diabetes Association noted that “18.7% of all African Americans ≥ 20 years of age, have diagnosed or undiagnosed diabetes, compared to 7.1% of non-Hispanic white Americans.”

The risk of developing diabetes was “77% higher among African Americans than among non-Hispanic white Americans.”

Going further back to 2006, “African Americans with diabetes were 1.5 times more likely to be hospitalized and 2.3 times more likely to die from diabetes than non-Hispanic whites” that year, according to the same editorial.

The authors also quoted an older 2003 report, in which the Institute of Medicine found that “African Americans, Hispanics, and Native Americans experience a 50–100% higher burden of illness and mortality from diabetes than white Americans.”

At the time, nearly 16.1% of AI/AN were living with diabetes, the highest prevalence of the condition of all U.S. racial and ethnic groups.


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