The Socioeconomic Gradient of Diabetes Prevalence, Awareness, Treatment, and Control Among African Americans in the Jackson Heart Study

Abstract

PURPOSE Little research has focused on the social patterning of diabetes among African Americans. We examined the relationship between socioeconomic status (SES) and the prevalence, awareness, treatment and control of diabetes among African Americans. METHODS Education, income and occupation were examined among 4,303 participants (women=2,726; men=1,577). Poisson regression estimated relative probabilities (RP) of diabetes outcomes by SES. RESULTS The prevalence of diabetes was 19.6% in women and 15.9% in men. Diabetes awareness, treatment and control were 90.0%, 86.8%, and 39.2% in women, respectively, and 88.2%, 84.4%, and 35.9% in men, respectively. In adjusted models, low-income men and women had greater probabilities of diabetes than high-income men and women (RP 1.94, 95%CI: 1.28–2.92; RP 1.35, 95%CI: 1.04–1.74, respectively). Lack of awareness was associated with low education and low occupation in women (RP 2.28, 95%CI 1.01–5.18, and RP 2.62, 95%CI 1.08–6.33, respectively) but not in men. Lack of treatment was associated with low education in women. Diabetes control was not patterned by SES. CONCLUSIONS Diabetes prevalence is patterned by SES, and awareness and treatment are patterned by SES in women but not men. Efforts to prevent diabetes in African Americans need to address the factors that place those of low SES at higher risk.

Life Course Socioeconomic Position and Subclinical Disease: The Jackson Heart Study

“…In another recently published study, investigators found that prevalent diabetes was significantly higher in lower vs high SEP African Americans with associations persisting after risk factor adjustment, which is similar to the relationships between LVH with income and PAD with education. 13 Educational attainment is a more stable measure of social class than income and appears to be more consistently predictive of Prior studies have demonstrated that childhood SEP affects the risks of CVD in adulthood. These studies typically included young adult populations and examined CIMT prevalence or progression.…”

“…8 Socioeconomic position (SEP) has been linked to CVD disparities, in that persons with low SEP have been shown to have greater CVD prevalence and risk than persons with higher SEP. 9 African Americans are more represented among the least educated, lowest income and low-skilled occupations than their White counterparts, 10,11 which suggests their SEP may explain some of the racial disparity in CVD. 1,12,13 Childhood and adult SEP independently and jointly contribute to an increased prevalence of CVD risk factors, subclinical disease, and CVD disparities. [14][15][16][17][18][19][20][21] Prior work has also shown that lower cumulative life course SEP was associated with increased prevalence of subclinical CVD 17,[22][23][24] among relatively smaller or non-African American samples.…”

Racial/Ethnic Variability in Diabetes Mellitus among United States Residents Is Unexplained by Lifestyle, Sociodemographics and Prognostic Factors

“…However, diabetes mellitus prevalence was not higher among Hispanics compared to Caucasians in both our crude and adjusted models. Whereas family income predicts diabetes mellitus prevalence among African Americans, similar claims could not be made of the Hispanics relative to Caucasians [7,[21][22][23][24][25][26][27][28].…”

Recruitment and Baseline Characteristics of Participants in the Lifestyle Improvement Through Food and Exercise (LIFE) Study

“…Further, understanding characteristics of this high-risk population is necessary to inform development of appropriately tailored interventions. 36 …”