The role of socioeconomic status in a community-based study of diabetes secondary prevention among African Americans

Abstract

ABSTRACT Objective: The implications for health interventions of socioeconomic diversity among African Americans is not well-studied. Design: Our one-arm community-based participatory research study was designed to improve blood sugar among African Americans with Type 2 diabetes through a six-month intervention combining peer support groups and professional individual coaching. Setting: Small Southern county with large, socioeconomically diverse African American population. Methods: Study participants were recruited through churches and other community sites from 2009-2012. Clinical status was measured and surveys administered at intervention beginning and end. Retention was operationalized as completion of six-month measurement. Bivariate associations between categorical variables were assessed using Pearson’s chi-square and between categorical and continuous variables using independent t-tests of means. Multiple logistic regression was conducted for retention and multiple linear regression for change in HbA1c (p<.05). Results: We enrolled a large, socioeconomically diverse African- American population (n=380) and, retention was high (85%). However, those who left the study were more likely than those retained to be uninsured (52.4% vs. 28.7%) and less likely to have education beyond high school (45.3% vs. 63.3%); their average household income per person was lower ($10,942 vs. $20,731). Multivariate analysis showed that this association between socioeconomic status and retention was mediated by higher baseline blood sugar and diabetes burden among those of lower socioeconomic status. Higher baseline blood sugar, but not SES, was associated with greater improvements in diabetes control. Conclusion: These findings indicate the importance of analyses that address socioeconomic status within racial groups as a determinant of participation in and outcomes from health interventions.