Diabetes disparities in the United States: Trends by educational attainment from 2001 to 2020

Ji Young Choi; Daesung Choi; Neil K Mehta; Mohammed K Ali; Shivani A Patel

doi:10.1016/j.amepre.2024.04.006

Diabetes disparities in the United States: Trends by educational attainment from 2001 to 2020

Am J Prev Med. 2024 Apr 12:S0749-3797(24)00131-4. doi: 10.1016/j.amepre.2024.04.006. Online ahead of print.

Authors

Ji Young Choi¹, Daesung Choi¹, Neil K Mehta², Mohammed K Ali³, Shivani A Patel⁴

Affiliations

¹ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.
² Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX.
³ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA.
⁴ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Electronic address: s.a.patel@emory.edu.

PMID: 38615980
DOI: 10.1016/j.amepre.2024.04.006

Abstract

Introduction: Tracking changes in socioeconomic disparities in diabetes in the US is important to evaluate progress in health equity and guide prevention efforts. Disparities in diabetes prevalence by educational attainment from 2001 to 2020 were investigated.

Methods: Using a serial cross-sectional design, data from 33,220 adults aged 30 to 79 assessed in nine rounds of the National Health and Nutrition Examination Surveys between 2001 to 2020 were analyzed in 2023-4. Diabetes was defined as self-reported prior diagnosis, elevated glycated hemoglobin (HbA_1c≥6.5%), or use of diabetes medications. Marginalized age- and covariate-adjusted prevalence differences (PD) and prevalence ratios (PR) of diabetes by educational attainment (less than high school graduation, high school graduation, some college education or associate degree, or college graduation [reference]) by calendar period (2001-04, 2005-08, 2009-12, 2013-16, 2017-20) were derived from logistic regression models.

Results: From 2001 to 2020, age-adjusted diabetes prevalence was consistently higher among adults without a college degree. Adults without a high school diploma exhibited the largest disparities in both 2001-04 (PD 8.0%; 95%CI 5.6-10.5 and PR 2.1; 95%CI 1.5-2.6) and 2017-20 (PD 11.0%; 95%CI 6.7-15.2 and PR 2.1; 95%CI 1.5-2.7). Between 2001-04 and 2017-20, the absolute disparity in diabetes increased only among adults with a high school diploma (PD 1.7% 95%CI -0.5-3.9 vs PD 8.8%; 4.1-13.4, respectively), while the PR did not change in any group. Education-related disparities in diabetes were attenuated after accounting for socio-demographic factors and BMI.

Conclusions: From 2001 to 2020, national education-related disparities in diabetes prevalence have shown no signs of narrowing.

Keywords: Diabetes; Disparities; Educational Attainment; Public Health; Surveillance.