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dcyphr | Impact of Race/Ethnicity and Social Determinants of Health on Diabetes Outcomes

Abstract

Diabetes patients seem to have different clinical outcomes based on their race. Understanding how cultural and racial factors affect these patients can bring about more efficient and humane care. It is possible that factors like food/housing insecurity, perceived discrimination, and mental health are not taken into consideration when caring for these patients. More research is necessary to determine how these conditions affect these patients in a clinical setting.


Burden of Type 2 Diabetes 


The CDC estimates that about 9.3% of the U.S. population has diabetes. Diabetes leads to many other symptoms and requires patients to be on other medications, such as for high blood pressure and cholesterol, stroke, and heart disease. These health risks, along with many others, contribute to a high financial burden on these patients.

The American South seems to have a higher rate of diabetes than other regions of the U.S. Other patterns include a higher rate of diabetes among non-Hispanic African-Americans and a lower rate of diabetes for those with a college degree. These patterns suggest the possibility of racial/ethnic factors, socioeconomic, and behavioral factors on increased burden of diabetes.


Racial Differences in Diabetes Outcomes


Non-Hispanic white people are much less affected by diabetes when compared to racial and ethnic minority groups. While only 7.6% of non-Hispanic white people had been diagnosed with diabetes in 2012, other racial and ethnic minorities ranged between 9% and 15.9%. Racial and ethnic minorities have also shown to suffer a higher burden of disease, leading to higher mortality rates and worse outcomes.

Despite extensive policies and programs to combat diabetes, minority populations are not often the people reaping the benefits.

Glycemic Control

        Glycemic control, measured by HbA1c, is important to minimize negative effects of diabetes. Minority groups seem to consistently fall below recommended guidelines for glycemic control (HbA1c<7%).

        There is research to support the idea that there is a significant difference in glycemic control between white people and people of other races and ethnicities. Despite various studies, samples, limitations, populations, etc. results tended to all suggest this, especially having an effect on non-Hispanic Black americans.


 Blood Pressure Control

        Maintaining control of blood pressure is critical for diabetic patients. Complications of high blood pressure can lead to blindness and kidney disease. Despite this knowledge, many diabetic patients of minority groups still disproportionately suffer from high blood pressure when compared to their white counterparts. Similar to glycemic control studies, blood pressure studies indicate that African Americans are especially affected by these patterns. Researchers have also found a similar pattern in veterans with type II diabetes, with non-Hispanic Black Veterans having much higher blood pressure than their white counterparts. Many of these studies adjusted for confounding variables, which helps establish the validity of these conclusions.


Lipid Control

        Along with glycemic and blood pressure control, lipid control is an important part of preventing complications in diabetes patients. In the southeastern U.S., lipid control was significantly lower for non-Hispanic Black Americans. In a similar study of veterans and lipid control in primary care clinics, researchers found that being African American or Hispanic correlated with significantly lower lipid control. This paper continues in outlining the results of several studies that share similar results.


Social Determinants of Health and Diabetes


The authors of this paper note that the contributions of social determinants on these clinical outcomes often go ignored. The term “social determinants” refers to any social factor (NOT biological, such as race, socioeconomic class, etc.) that can cause certain groups of people to have systematically different health outcomes when compared to other groups of people. In this case, racial and ethnic minorities are disproportionately affected by poor health outcomes when compared to white people. Studies from multiple countries provide evidence that people of lower socioeconomic class and without higher education (college) have an increased risk of diabetes and mortality-rates.

Authors of this paper found that existing studies show little interest in exploring how these social determinants lead to higher risks of health complications. However, there was one analysis that showed that financial stress, poor education, and living in a disadvantaged community contribute to depressive symptoms and increased A1c levels. Conditions such as low health literacy, and isolation also contributed to increased A1c levels. Researchers found that differences in health care provider, insurance, and frequency of doctor visits did not have as significant of an effect when compared to how differences in race and ethnicity did.

The authors of this paper encourage for more research in how these social factors bring about poor health outcomes.


Psychosocial Factors and Diabetes 


Psychosocial describes an individual’s social situation and how it interacts with their psychological state. Researchers suggest that these types of factors may have an affect on how someone manages their diabetes, bringing about worse health outcomes

Other experiments affirm that there are direct and indirect effects of these psychosocial factors on health outcomes. These include self-care, access to care, and the process of receiving care. Studies out of Iran, Turkey, and China support these findings in that they suggest that health professionals should treat diabetes through psychological and behavioral means as well.

 

Neighborhood Factors and Diabetes

An individual’s community can have influence on health, through factors such as crime rates, sense of community, access to healthy foods, health care, and attitudes toward health. A study from rural Georgia on African Americans found that subjects claimed there were few “recreational options” and that they were financially inaccessible.

20% of diabetes patients report being food insecure, or not having easy access to healthy food. However, food insecurity did not seem to have a direct affect on A1c levels, suggesting it may have more of a psychosocial effect on self-management behaviors.

Additionally, discrimination and stress have a significant effect on health outcomes and how individuals manage chronic diseases. This is true for multiple diseases.

 

Behavioral Factors and Diabetes

Behavioral factors can include eating healthily, listening to medical professionals, being physically active, and self-monitoring things such as blood glucose levels. Establishing these healthy behaviors contributes to better health outcomes among diabetes patients.

 

Conclusion

      Based on the authors’ review of research, evidence suggests that race/ethnicity and associated social determinants significantly impact health outcomes of diabetes patients. They suggest further research into how these factors affect diabetes patients, as well as using the research to intervene and improve health outcomes of these patients.