Racial and Ethnic Disparities in Diabetes Complications in the Northeastern United States: The Role of Socioeconomic Status

• Published in: Journal of the National Medical Association Vol. 105; no. 1; pp. 51 - 58
• Main Authors: Osborn, Chandra Y., PhD, MPH, Groot, Mary de, PhD, Wagner, Julie A., PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2013; Elsevier Limited
• Subjects: diabetes; Diabetes Complications - ethnology; Ethnic Groups; Female; health disparities; Health Status Disparities; Humans; Internal Medicine; Male; Middle Aged; minority health; Morbidity - trends; New England - epidemiology; Retrospective Studies; Risk Factors; Social Class; socioeconomic status; New England; minority health; health disparities; diabetes; socioeconomic status
• ISSN: 0027-9684; 1943-4693
• DOI: 10.1016/S0027-9684(15)30085-7

Abstract The role of socioeconomic status (SES) in explaining racial/ethnic disparities in diabetes remains unclear. We investigated disparities in self-reported diabetes complications and the role of macro (eg, income, education) and micro (eg, owning a home or having a checking account) SES indicators in explaining these differences. The sample included individuals with a diagnosis of diabetes (N = 795) who were aged, on average, 55 years, and 55.6% non-Hispanic white, 25.0% African American, and 19.4% Hispanic. Approximately 8% reported nephropathy, 35% reported retinopathy, and 16% reported cardiovascular disease. There were significant disparities in the rates of complications among non-Hispanic white, African American, and Hispanic participants, with Hispanic participants having the highest rates of nephropathy, retinopathy, and cardiovascular disease. Macro SES indicators (eg, income) mediated racial differences (ie, non-Hispanic whites vs African Americans) in self-reported retinopathy, a combination of macro and more micro SES indicators (eg, education, income, and owning a home or having a checking account) mediated racial/ethnic differences (ie, non-Hispanic white vs Hispanic participants) in self-reported cardiovascular disease, and only micro SES indicators (eg, owning a home or having a checking account) mediated differences between lower-income SES racial/ethnic minority groups (ie, African American vs Hispanic participants) in self-reported retinopathy and cardiovascular disease. Findings underscore that indicators of SES must be sensitive to the outcome of interest and the racial/ethnic groups being compared.