Socioeconomic Disparities in Diabetes Prevalence Widen in US

Kristin Jenkins

November 23, 2016

The latest data from the National Health Interview Survey (NHIS) for 1999 to 2002 and 2011 to 2014 confirm that socioeconomic disparities in the prevalence of diagnosed diabetes in US adults are widening over time.

Factors such as limited education and low income appear to be driving these disparities and could inhibit the effectiveness of interventions to reduce the risk of type 2 diabetes in certain ethnic groups, including non-Hispanic whites, say Gloria L Beckles, MD, and Chiu-Fang Chou, DrPH, of the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

The results were published online in Morbidity and Mortality Weekly Report.

"The persistent widening of the socioeconomic position gap in the prevalence of physician-diagnosed diabetes observed in this study is consistent with an increasing body of evidence that suggests interventions to reduce diabetes or its risk factors can have different impacts according to socioeconomic position," the researchers say.

"Public-health professionals and policymakers may consider adapting or developing interventions that take into account limited education and low income to reach people who may be at significant risk for type 2 diabetes."

Targeting Interventions to Those Who Need Them Most

The results of the study show that between 1992 and 2002 both the average difference in diabetes prevalence from the lowest to highest education group and average difference across income-to-poverty ratio (IPR) were 4.7 percentage points (ppt).

Between 2011 and 2014, this climbed to an absolute difference of 6.1 ppt for education and 7.1 ppt for IPR, an increase of at least 40% in the overall population.

These socioeconomic position disparities in diabetes prevalence widened over time in Hispanic and white populations, but not in black populations (although in the latter, the magnitude of disparities remained the same).

Dr Beckles told Medscape Medical News that current evidence-based approaches for type 2 diabetes prevention are helping to reduce risk, but the effects of these interventions "may be experienced unevenly, benefiting those with greater socioeconomic resources compared with those in socioeconomically disadvantaged positions."

"Evaluation of the effectiveness of such interventions across socioeconomic groups might be critical to understanding whether risk-reduction efforts achieve the national health equity goal," she and her colleagues say.

She cautioned that treatment of prediabetes and prevention of type 2 diabetes can't be given a "one-size-fits-all approach."

More than 86 million Americans have prediabetes and nearly 90% don't know it, she pointed out, adding that without effective intervention many will develop type 2 diabetes within 5 years.

These latest results indicate that clinicians should consider the impact of socioeconomic disadvantage on patient compliance, she suggested.

To set the most realistic goals and provide the best support, factors such as income, education, and literacy skills need to be taken into account when considering public-health interventions to delay or prevent diabetes.

Discussing written instructions while the patient is in the doctor's office and making sure patient education materials are easy to understand and available in different languages are key. And patients without insurance may need information about community resources and prescriptions for generic medications.

Dr Beckles also suggested several programs and resources that may help physicians target those most in need.

Last year, the CDC and American Medical Association launched Prevent Diabetes STAT, which has an online tool kit with information on screening and referring high-risk patients to community diabetes prevention programs. An online screening tool also helps patients determine their risk for type 2 diabetes.

And the National Diabetes Prevention Program tailors lifestyle intervention to the individual, and there are hundreds of programs across the country that can be attended in person or virtually, noted Dr Beckles. "Program participants can cut their risk of type 2 diabetes by 58%," she added.

Finally, as part of the National Diabetes Education Program, the CDC has developed fact sheets, tool kits, booklets, CDs, DVDs, webinars, and other materials "using principles of plain language and health literacy," she emphasized.

The authors have reported no relevant financial relationships.

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MMWR Morb Mortal Wkly Rep. 2016;65:1265-1269. Article

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