Disparities in Environmental Exposures to Endocrine-Disrupting Chemicals and Diabetes Risk in Vulnerable Populations

Abstract

Burgeoning epidemiological, animal, and cellular data link environmental endocrine-disrupting chemicals (EDCs) to metabolic dysfunction. Disproportionate exposure to diabetes-associated EDCs may be an underappreciated contributor to disparities in metabolic disease risk. The burden of diabetes is not uniformly borne by American society; rather, this disease disproportionately affects certain populations, including African Americans, Latinos, and low-income individuals. The purpose of this study was to review the evidence linking unequal exposures to EDCs with racial, ethnic, and socioeconomic diabetes disparities in the U.S.; discuss social forces promoting these disparities; and explore potential interventions. Articles examining the links between chemical exposures and metabolic disease were extracted from the U.S. National Library of Medicine for the period of 1966 to 3 December 2016. EDCs associated with diabetes in the literature were then searched for evidence of racial, ethnic, and socioeconomic exposure disparities. Among Latinos, African Americans, and low-income individuals, numerous studies have reported significantly higher exposures to diabetogenic EDCs, including polychlorinated biphenyls, organochlorine pesticides, multiple chemical constituents of air pollution, bisphenol A, and phthalates. This review reveals that unequal exposure to EDCs may be a novel contributor to diabetes disparities. Efforts to reduce the individual and societal burden of diabetes should include educating clinicians on environmental exposures that may increase disease risk, strategies to reduce those exposures, and social policies to address environmental inequality as a novel source of diabetes disparities.

Transcultural Diabetes Care in The United States – A Position Statement by the American Association of Clinical Endocrinologists

“…Poverty is associated with fatalism, dependency, need for governmental aid, drug and alcohol use, stresses on family life, low self-esteem, community disengagement, increased risk for disease and complications, and decreased access to quality health care, but also gaps in formal populationspecific recommendations (4,161). Moreover, there are environmental inequalities or disparities in exposure to endocrine-disrupting compounds (endocrine discrupting chemicals or EDCs; polychlorinated biphenyls, organochlorine pesticides, air pollutants, bisphenol A, and phthalates) (162). This socio-economic correlate involving EDCs affects diabetes prevalence rates (162).…”

“…Moreover, there are environmental inequalities or disparities in exposure to endocrine-disrupting compounds (endocrine discrupting chemicals or EDCs; polychlorinated biphenyls, organochlorine pesticides, air pollutants, bisphenol A, and phthalates) (162). This socio-economic correlate involving EDCs affects diabetes prevalence rates (162).…”

Underutilized and Under Threat: Environmental Policy as a Tool to Address Diabetes Risk

“…A number of these measures have been associated with diabetes risk and outcomes (reviewed in Ref. [9••]). For example, some studies have demonstrated that increased exposure to fine particulate matter (PM 2.5 ) is associated with dynamic changes in insulin resistance [10, 11] and prevalent diabetes [12, 13].…”

“…Similarly, individuals with lower incomes and less education are more likely to have diabetes [57]. While several factors have been proposed to contribute to these differences [37], a recent analysis suggests that differential exposures to diabetes-promoting EDCs may contribute to disease disparities among African Americans, Hispanics, and those with low incomes [9••].…”

A comprehensive analysis of racial disparities in chemical biomarker concentrations in United States women, 1999-2014

“…A mechanistic understanding of racial disparities in disease therefore requires a characterization of differences in environmental risk factors. In particular, differences in chemical exposures have been hypothesized to be important etiologic factors in racial disparities of disease rates (Hoover et al 2012; Juarez and Matthews-Juarez 2018; Ruiz et al 2018; Wang et al 2016; Zota and Shamasunder 2017).…”