Social Epidemiology of Diabetes

Diabetes is a condition that has many variables. Researchers are finding more and more about how genetics and patient behavior play a role; however, it turns out that socioeconomic status, education, and ethnic background all play a role as well.

On Monday afternoon, Jessica Robbins, PhD, member of the Philadelphia Department of Public Health and Adjunct Professor at Drexel, presented on the role of socioeconomic status in diabetes risk and outcomes. The overarching framework used for this discussion was the social ecological framework. Dr. Robbins presented alarming data regarding the disparity of diabetes prevalence both in terms of racial background and socioeconomic status. Here are some of the general observations that Dr. Robbins presented along with references to both local and national studies:

• The African American population continues to show more susceptibility to diabetes than non-Hispanic whites, and this pattern is consistent across many studies
• Household income is an excellent predictor of diabetes prevalence; households with $50,000/year in income had half as much a rate of incidence (5%) as those which have $35,000/year (10%)
• Exploring Health Disparities in Integrated Communities (EHDIC) Study found that whites and African Americans in integrated communities had similar odds of having diabetes, despite substantial racial/ethnic disparities at the population level
• Diabetes disparities are greater in women than men, both in terms of racial background and socioeconomic status
• Disparities decline by age, especially among the very old, although this may reflect measuring issues
• Some studies have found that those who go to college have the lowest risk of contracting diabetes, both in racial and gender groups
• The DISTANCE cohort study (Kaiser Permanente Southern California) found disparities in glycemic control and other intermediate clinical outcomes were associated with the socioeconomic status of patients’ area of residence

Although there have been numerous studies conducted to analyze the various factors that are associated with diabetes, there still remains widespread debate as to which factors are more revealing than others, especially when considering that many of these factors are interrelated. However, Dr. Robbins concluded by saying that the effects of socioeconomic status on diabetes outcomes are without question “big, not inevitable, and unacceptable.”

For more information on this session, please visit the American Diabetes Association’s website.