American Diabetes Month: Disparities persist and numbers are highest among American Indians and Alaska Natives
Some groups of people are affected by diabetes more than other groups. Differences in health status or access to healthcare among racial, ethnic, geographic, and socioeconomic groups are referred to as health disparities. Among US adults aged 18 years or older, the prevalence of diagnosed diabetes is highest among American Indians/Alaska Natives (14.7%), people of Hispanic origin (12.5%), and non-Hispanic Blacks (11.7%), followed by non-Hispanic Asians (9.2%) and non-Hispanic Whites (7.5%). This is according to the latest estimates for 2017-2018, presented in the National Diabetes Statistics Report, 2020.
A publication of the US Centers for Disease Control and Prevention (CDC), the analysis reveals that American Indians/Alaska Natives had the highest prevalence of diagnosed diabetes for women at 14.8%. American Indian/Alaska Native men had a significantly higher prevalence of diagnosed diabetes (14.5%) than non-Hispanic Black (11.4%), non-Hispanic Asian (10.0%) and non-Hispanic White (8.6%) men.
Besides, the percentage of adults living with diagnosed or undiagnosed diabetes in 2017-2018 varied significantly by racial and ethnic groups and among subgroups of Hispanics and non-Hispanic Asians. Among adults of Hispanic origin, Mexicans (14.4%) and Puerto Ricans (12.4%) had the highest prevalence, followed by Central/South Americans (8.3%) and Cubans (6.5%). Among non-Hispanic Asians, Asian Indians (12.6%) and Filipinos (10.4%) had the highest prevalence, followed by Chinese (5.6%). Other Asian groups had a prevalence of 9.9%.
“Differences in diabetes prevalence are seen in the overall US population and within racial and ethnic groups according to socioeconomic position, which is defined by the level of education attained and the income-to-poverty ratio. For example, the prevalence of diabetes has increased among non-Hispanic Whites with less education and lower incomes and among Hispanics with less education,” the findings state.
The CDC defines prevalence as the proportion of persons who have a condition at or during a particular period. Incidence, on the other hand, refers to the proportion or rate of persons who develop a condition during a particular period. So prevalence and incidence are similar, but prevalence includes new and pre-existing cases, whereas incidence includes new cases only.
Among US adults aged 18 years or older, 2017-2018 data indicated that non-Hispanic Blacks (8.2 per 1,000 persons) and people of Hispanic origin (9.7) had a higher incidence compared to non-Hispanic Whites (5.0).
2019 study found more Hispanics, Blacks living with it than Whites
In 2019, the CDC examined in detail the percentage of people living with diagnosed and undiagnosed diabetes in Hispanic and non-Hispanic Asian subpopulations. The data fill a national surveillance gap in Hispanic and Asian populations in the US. The percentage of adults living with diagnosed and undiagnosed diabetes varied considerably by race/ethnicity and among Hispanic and non-Hispanic Asian subgroups. Broadly, the age-sex-adjusted percentage of adults living with diagnosed or undiagnosed diabetes was 22% in Hispanics, 20% in non-Hispanic Blacks, 19% for non-Hispanic Asians and 12% for non-Hispanic Whites.
The US is an increasingly diverse nation, as Hispanics and non-Hispanic Asians collectively now account for 23% of the US population and are expected to account for 38% by 2060, according to Census data. According to the authors, these groups may be at higher risk for type 2 diabetes due to genetic, lifestyle, and environmental factors.
“This landmark diabetes survey provides essential data that will better inform public health efforts to reach more Americans with tailored, effective prevention and treatment strategies. This defined data on the prevalence of diabetes among Hispanic and Asian demographic groups can help healthcare providers and patients reduce the risk for type 2 diabetes,” explains CDC Director Dr Robert R Redfield.
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Among some Hispanics, the age-sex-adjusted percentage of adults living with both diagnosed and undiagnosed diabetes was 25% for Mexicans, 22% for Puerto Ricans, 21% for Cuban/Dominicans, 19% for Central Americans, and 12% for South Americans. Among some non-Hispanic Asians, the age-sex-adjusted percentage of adults living with both diagnosed and undiagnosed diabetes was 23% for South Asians, 22% for Southeast Asians and 14% for East Asians.
Consistent with previous research, Asians have lower body mass index (BMI) levels compared to other racial/ethnic groups. In this study, after adjusting for age, sex, and BMI, Southeast Asians had the highest percentages of adults living with diagnosed and undiagnosed diabetes among Asian subgroups.
“These important findings establish a baseline for future national diabetes estimates for Hispanic and non-Hispanic Asian subgroups and highlight differences in the diabetes burden in these groups. These data also provide insights that allow us to reach groups at higher risk and provide opportunities to strengthen diabetes detection and type 2 diabetes prevention and care in these groups,” writes Dr Ann Albright, director of CDC’s Division of Diabetes Translation.
Most health professionals rely on BMI to assess whether their patients are overweight or have obesity (BMI of 25 or greater). However, since Asian Americans may be at risk for type 2 diabetes even at normal weight ranges, experts are now suggesting that people of Asian heritage get tested if their BMI is 23 or greater.
What about children and adolescents?
The CDC has also examined the prevalence and incidence of diabetes among children and adolescents younger than age 20 years. While the number of new cases of type 1 diabetes in 2018 was highest among Whites, the annual percentage change in the number of new cases during 2002-2015 was higher for all other racial and ethnic groups. The sharpest increase was among Asians or Pacific Islanders (4.4%), Hispanics (4.0%), and Blacks (2.7%). Incidence of type 1 diabetes was higher among Whites than among racial and ethnic minority groups.
Similarly, for type 2 diabetes, the highest annual percentage change was seen among Asians or Pacific Islanders (7.7%), Hispanics (6.5%), and Blacks (6.0%) during 2002-2015. The incidence of type 2 diabetes was significantly higher among racial and ethnic minority groups than among Whites.
Race and ethnicity are also a factor in prediabetes. Prevalence of prediabetes among non-Hispanic Black (22.7%) and Hispanic (22.5%) adolescents is also higher than among non-Hispanic White (15.8%) adolescents.
What’s being done to address the disparities?
The CDC’s diabetes prevention and educational programs and initiatives are working to end health disparities in high-risk and vulnerable populations. The agency-led National Diabetes Prevention Program is a partnership of public and private organizations working together to deliver an affordable, evidence-based lifestyle change program to help people with prediabetes prevent or delay type 2 diabetes.
However, some racial and ethnic minority groups are enrolling in the program at lower rates than other groups, say experts. “To help increase access, CDC has funded 10 national organizations to start new in-person programs in underserved areas (regions with fewer resources to address health disparities). In addition to in-person delivery, the program can also be delivered online, by distance learning, and through a combination of these formats. Working with a trained lifestyle coach, program participants learn to make better food choices, be more physically active, and find ways to cope with problems and stress. These lifestyle changes can cut their risk of developing type 2 diabetes by as much as 58% (71% for those over 60),” explains the agency.
Among other programs, the Appalachian Diabetes Control and Translation Project is designed to reduce the impact of type 2 diabetes among people who live in high-risk, economically distressed Appalachian communities by expanding public engagement and promoting behavioral change, scaling and sustaining the National Diabetes Prevention Program, expanding regional coalitions, and leveraging local resources.
Since American Indians and Alaska Natives are more likely to have type 2 diabetes than any other US racial group, the Native Diabetes Wellness Program supports wellness and diabetes awareness by collecting and retelling stories about tribal efforts to reclaim traditional foods; developing colorful books for children to promote healthy eating and physical activity; and providing access to other helpful resources, which can be downloaded or ordered for free.