Abstract
Background: Diabetes Mellitus affects 12.7% non-Hispanic Black adults as opposed to 7% non-Hispanic White Adults. We hypothesized that higher structural racism (SR) is associated with greater diabetes prevalence among Black and White adults. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study recruited 30,239 US Black and White adults from 48 contiguous US states in 2003-2007. We linked a novel county-level structural racism (CSR) metric reflecting domains of housing dissimilarity, school dissimilarity, high school graduation, incarceration, poverty, primary care access, and ambulatory care access. CSR was determined linked to REGARDS participants’ county location at time of recruitment. Diabetes was defined as fasting blood glucose ≥126 mg/dL or random blood glucose ≥200 mg/dL or use of diabetes medications. We excluded those missing CSR score and diabetes status. Poisson regression estimated relative risk (RR) of prevalent diabetes by higher (more adverse) CSR. Results: Among the 28,329 included participants (mean [SD] age 65 years, [9.43], 55% female participants, 42% Black participants). There was a greater proportion of Black adults in areas with higher CSR. As is shown in Table 1 , higher CSR was associated with higher RR of prevalent diabetes overall. However, higher CSR was associated with lower RR in race stratified models. Conclusions: Adverse levels of CSR were associated with lower diabetes prevalence in Black adults. It is unclear if this observation reflects operationalization of CSR, omitted variable bias, survival bias, or a true structural racism-diabetes association. Table 1 - Relative risk (RR) of Diabetes Prevalence age and sex adjusted per 1-point higher CSR*
Published Version
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