April 21, 2021
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According to a study published in Diabetes Research and Clinical Practice, diabetes death rates in the United States were more than double that of white adults in black adults from 2008 to 2017.
Joanna Buscemi
“The main cause of inequalities in diabetes mortality is likely to be due to systemic racism and oppression.” Joanna Buscemi, PhD, a clinical psychologist and assistant professor in the Department of Psychology at DePaul University, said Healio. “The best solutions would be policies that limit insulin costs and improve access to health care, fruits and vegetables, and physical activity. Doctors should advocate such guidelines to close diabetes and other health inequalities. “
Diabetes mortality more than doubled for black Americans compared to white Americans in the 30 largest US cities from 2013 to 2017. The data are from Buscemi J, et al. Diabetes Res Clin Pract. 2021; doi: 10.1016 / j.diabres.2021.108652.
Buscemi and colleagues calculated diabetes death rates from 2008 to 2017 using data from the National Vital Statistics System’s multiple causes of death file. Diabetes mortality included any death listed as an underlying cause of diabetes. Diabetes death rates were calculated for the 30 largest US cities according to 2013 data from the US Census Bureau. The American Community Survey estimates from 2010 and 2015 were used to calculate the size of the white population, as well as the US Census Bureau data from 2010 and the American Community Survey estimates from 2010 to 2015 were used to calculate the black population size. The diabetes death rates were also calculated for a period of 5 years from 2008 to 2012 and a further period of 5 years from 2013 to 2017.
The diabetes death rate in the United States increased from 20.91 per 100,000 people in 2008 to 2012 to 21.05 per 100,000 from 2013 to 2017. El Paso, Texas and Memphis, Tennessee had the two highest death rates in both periods. San Antonio had the third highest diabetes death rate from 2008 to 2012 and Baltimore had the third highest diabetes death rate from 2013 to 2017. The city with the lowest diabetes death rate in both periods was San Francisco.
Racial inequalities
The diabetes death rate for black adults from 2008 to 2012 was 41.49 per 100,000 people – 2.29 times higher than the white adult rate of 18.1 per 100,000. The diabetes death rate from 2013 to 2017 decreased to 40.36 per 100,000 in black adults and rose to 18.27 per 100,000 in white adults.
Washington, DC, had from 2008 to 2012 (IRR = 6.15; 95% CI, 4.58-8.25) and from 2013 to 2017 (IRR = 6.82; 95% CI; 4.92-9, 44), while Detroit both 2008 to 2012 (IRR = 1.31; 95% CI, 1.07-1.61) and 2013 to 2017 (IRR = 1.51; 95% CI, 1.2-1, 9) had the lowest IRR. Buscemi said it was surprising to see such a large racial gap in diabetes death rates in Washington, DC
“In Washington, DC, stations 7 and 8, food deserts are the foreground, unemployment rates are highest, and 90% of the population are black,” Buscemi said. “These neighborhoods are disproportionately affected by chronic disease and could benefit from wealth creation initiatives, improved access to government programs that improve access to health care, and community members to help them manage their health care and disease management. This would go a long way in improving the life expectancy of black Americans with diabetes. “
From 2013 to 2017, when compared to 2008–2012, Chicago, Los Angeles, and Oklahoma City had increases in diabetes racial inequalities, while Louisville, Kentucky, and Phoenix had decreases in inequalities. From 2013 to 2017, there were 7,365 deaths among black adults from racial inequalities in diabetes mortality, with New York having the highest number of deaths among black people with diabetes.
“Black patients with diabetes may be at greater risk of death from diabetes and can benefit from community health workers, patient navigators, or other community resources to attend appointments, treat their disease and afford their medication,” Buscemi said.
Best and worst performing cities
The researchers categorized each city into a quadrant based on whether its diabetes death rate and racial inequality in diabetes mortality were above or below the national average. Boston, Dallas, and Denver were identified as the “best performing” cities with diabetes mortality rates and racial inequality in diabetes mortality rates below the national average. There were 13 cities described as “worst performing” with diabetes death rates and racial inequality above the national average: Memphis, Tennessee; San Antonio; Fort Worth, Texas; Oklahoma City; Phoenix; San Jose, California; Portland, Oregon; Jacksonville, Florida; Indianapolis; Houston; Nashville, Tennessee; Las Vegas; and Los Angeles.
“Cities with the highest inequalities in diabetes mortality should focus their funding and intervention efforts on improving equity for black Americans,” the researchers wrote.
For more informations:
Joanna Buscemi, PhD, can be reached at jbuscem2@depaul.edu.
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