American Diabetes Association
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Risk Factors Amenable to Primary Prevention of Type 2 Diabetes Among Disaggregated Racial and Ethnic Subgroups in the United States

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posted on 2023-11-27, 20:24 authored by Alain K. Koyama, Kai McKeever Bullard, Stephen Onufrak, Fang Xu, Ryan Saelee, Yoshihisa Miyamoto, Meda E. Pavkov

Race and ethnicity data disaggregated into detailed subgroups may reveal pronounced heterogeneity in diabetes risk factors. We therefore used disaggregated data to examine the prevalence of type 2 diabetes risk factors related to lifestyle behaviors and barriers to preventive care, among adults in the United States. We conducted a pooled cross-sectional study of 3,437,640 adults aged ≥18 in the United States without diagnosed diabetes from the Behavioral Risk Factor Surveillance System (2013–2021). Self-reported race and ethnicity included: Hispanic (Cuban, Mexican, Puerto Rican, Other Hispanic), Non-Hispanic (NH) American Indian/Alaska Native, NH Asian (Chinese, Filipino, Indian, Japanese, Korean, Vietnamese, Other Asian), NH Black, NH Pacific Islander (Guamanian/Chamorro, Native Hawaiian, Samoan, Other Pacific Islander), NH White, NH Multiracial, NH Other. Risk factors included: current smoking, hypertension, overweight or obesity, physical inactivity, being uninsured, not having a primary care doctor, healthcare cost concerns, and no physical exam in the past 12 months. Prevalence of hypertension, lifestyle factors and barriers to preventive care showed substantial heterogeneity among both aggregated, self-identified racial and ethnic groups and disaggregated subgroups. For example, the prevalence of overweight or obesity ranged from 50.8% (95% confidence interval [CI], 49.1–52.5) among Chinese adults to 79.8% (73.5–84.9) among Samoan adults. Prevalence of being uninsured among Hispanic subgroups ranged from 11.4% (10.9–11.9) among Puerto Rican adults to 33.0% (32.5–33.5) among Mexican adults. These findings underscore the importance of using disaggregated race and ethnicity data to accurately characterize disparities in type 2 diabetes risk factors and access to care.


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